Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 18667 | CA |
NPI | 1245302959 |
---|---|
Provider Name | Dr. Casey James Terribilini |
First Address | San Jose, CA 95124-2674 |
Second Address | San Jose, CA 95124-2674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |