Healthcare Provider Details

I. General information

NPI: 1972140200
Provider Name (Legal Business Name): JEFFERY CASIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12671 JERSEY CIR W
THORNTON CO
80602-4657
US

IV. Provider business mailing address

PO BOX 29141
THORNTON CO
80229-0141
US

V. Phone/Fax

Practice location:
  • Phone: 720-676-5743
  • Fax:
Mailing address:
  • Phone: 720-676-5743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: