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General NPI Number Information
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NPI Number | 1144533084
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Entity Type | Organization
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Legal Business Name | CASITAS DIAGNOSTICS INC
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 707 S UNIVERSITY AVE
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City | BEAVER DAM
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State | WI
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Zip | 53916-3027
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Country | US
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Telephone | 888-754-0451
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Fax |
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Provider Business Mailing Address
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Address Line | 11490 BURBANK BLVD STE 1D
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-2389
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Country | US
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Telephone | 888-754-0451
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSHUA PIERCE
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Credential | M.D.
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Telephone | 888-754-0451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 53D0662012
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License Number State | WI
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