Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 29898 | CA |
Y | 103T00000X | Psychologist | 29898 | CA |
NPI | 1013339985 |
---|---|
Provider Name | Dr. Mitchel Cory Casados |
First Address | Fresno, CA 93727-1571 |
Second Address | Fresno, CA 93727-1571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2014 |
Last Update Date | 22/11/2021 |