Healthcare Provider Details

I. General information

NPI: 1942231618
Provider Name (Legal Business Name): CASA VERDE PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LENNON LN STE 203
WALNUT CREEK CA
94598-2483
US

IV. Provider business mailing address

301 LENNON LN STE 203
WALNUT CREEK CA
94598-2483
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-7334
  • Fax: 925-939-7340
Mailing address:
  • Phone: 925-939-7334
  • Fax: 925-939-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG083245
License Number StateCA

VIII. Authorized Official

Name: DR. LISA M ASTA
Title or Position: PRESIDENT
Credential: MD
Phone: 925-939-7334