1265566996 NPI number — MRS. TRISTANA NICOLE CASEY MFT MFC 44348

Table of content: MRS. TRISTANA NICOLE CASEY MFT MFC 44348 (NPI 1265566996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265566996 NPI number — MRS. TRISTANA NICOLE CASEY MFT MFC 44348

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASEY
Provider First Name:
TRISTANA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT MFC 44348
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265566996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9029 PARK PLAZA DRIVE
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-697-0476
Provider Business Mailing Address Fax Number:
619-697-0505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9029 PARK PLAZA DRIVE
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-697-0476
Provider Business Practice Location Address Fax Number:
619-697-0505
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 44348 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MFC 44348 . This is a "BBS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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