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General NPI Number Information
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NPI Number | 1922839133
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Entity Type | Individual
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Provider Name | BERENICE CONCEPCION CASAVANTES SIAS
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Gender | Female
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 1001 S HALE AVE SPC 54
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City | ESCONDIDO
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State | CA
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Zip | 92029-2177
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Country | US
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Telephone | 858-729-8295
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Fax |
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Provider Business Mailing Address
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Address Line | 874 ADA ST # 1
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City | CHULA VISTA
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State | CA
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Zip | 91911-2636
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Country | US
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Telephone | 619-735-0864
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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