Healthcare Provider Details

I. General information

NPI: 1679269229
Provider Name (Legal Business Name): SANTIA CASAGRAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3376 S EASTERN AVE STE 188A
LAS VEGAS NV
89169-3380
US

IV. Provider business mailing address

5713 CLIFF POINT CT
LAS VEGAS NV
89149-5144
US

V. Phone/Fax

Practice location:
  • Phone: 702-490-9009
  • Fax: 866-737-6147
Mailing address:
  • Phone: 812-604-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10549-M
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: