Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 169329 | CA |
NPI | 1114344025 |
---|---|
Provider Name | Ryan M Casserly |
First Address | Monterey, CA 93940-4541 |
Second Address | Monterey, CA 93940-4541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2014 |
Last Update Date | 04/08/2020 |