Basic Information
Provider Information
NPI: 1033558556
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASEY
FirstName: TANYA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: FAUCHON
OtherFirstName: TANYA
OtherMiddleName:  
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 2821 OCEANSIDE BLVD
Address2:  
City: OCEANSIDE
State: CA
PostalCode: 920544800
CountryCode: US
TelephoneNumber: 7607212781
FaxNumber:  
Practice Location
Address1: 2821 OCEANSIDE BLVD
Address2:  
City: OCEANSIDE
State: CA
PostalCode: 920544800
CountryCode: US
TelephoneNumber: 7607212781
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2013
LastUpdateDate: 09/03/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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