Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | F3424 | TX |
NPI | 1063400836 |
---|---|
Provider Name | Dr. Carmen Cecilia Casas |
First Address | Corpus Christi, TX 78413-3782 |
Second Address | Corpus Christi, TX 78413-3782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83J076 | BLUE CROSS BLUE SHIELD (01) | TX |
C14264 | (02) | TX |