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NPI Code Detail

MEDICARE: CASEY COLLAZO

MEDICARE: CASEY COLLAZO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2247200000XOther Technician

General Provider Information

NPI Number : 1215477856
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY COLLAZO
Provider Business Mailing Address
First Line : 295 89TH ST STE 306
Second Line :
City : DALY CITY
State : CA
Zip : 94015-1656
Country : US
Telephone Number : 877-264-6747
Fax Number : 877-539-7730
Provider Business Practice Location Address
First Line : 2525 CAMINO DEL RIO S STE 335
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3743
Country : US
Telephone Number : 877-264-6747
Fax Number : 877-539-7730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2017
Last Update Date : 04/04/2023

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Directions to “ CASEY COLLAZO ” Practice Location

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