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General NPI Number Information
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NPI Number | 1043317050
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Entity Type | Individual
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Provider Name | ROBERT JOHN CASQUEJO PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 10900 N SCOTTSDALE RD STE 506
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5236
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Country | US
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Telephone | 480-596-1110
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Fax | 480-596-9969
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Provider Business Mailing Address
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Address Line | 11000 N SCOTTSDALE RD STE 120
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6169
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Country | US
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Telephone | 480-596-1110
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Fax | 480-596-9969
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601003745
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4217
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License Number State | AZ
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