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General NPI Number Information
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NPI Number | 1194378158
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Entity Type | Organization
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Legal Business Name | CASBRA BEHAVIORAL HEALTH, INC.
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 1152 N HOHOKAM DR STE 4
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City | NOGALES
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State | AZ
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Zip | 85621-1373
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Country | US
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Telephone | 520-225-8465
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Fax |
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Provider Business Mailing Address
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Address Line | 1152 N HOHOKAM DR STE 4
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City | NOGALES
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State | AZ
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Zip | 85621-1373
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Country | US
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Telephone | 520-225-8465
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. CASSANDRA BETH DIAZ DE LEON
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Credential | DNP, PMHNP-BC, BSN
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Telephone | 520-225-8465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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