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General NPI Number Information
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NPI Number | 1366581373
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Entity Type | Individual
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Provider Name | JODI CASADOS MD
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | #14, COUNTY ROAD 0324, HWY 84
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City | TIERRA AMARILLA
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State | NM
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Zip | 87575-0250
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Country | US
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Telephone | 505-588-7252
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250 #14, COUNTY RD 0324, HWY 84
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City | TIERRA AMARILLA
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State | NM
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Zip | 87575-0250
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Country | US
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Telephone | 505-588-7252
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2004-0458
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License Number State | NM
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