Healthcare Provider Details

I. General information

NPI: 1801331632
Provider Name (Legal Business Name): JONATHAN CASERO ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 DE SOTO DR
MIRAMAR FL
33023-4751
US

IV. Provider business mailing address

2642 DE SOTO DR
MIRAMAR FL
33023-4751
US

V. Phone/Fax

Practice location:
  • Phone: 954-268-7723
  • Fax:
Mailing address:
  • Phone: 954-268-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberAL3140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: