Provider Demographics
NPI:1033519855
Name:CASA PEDIATRICS
Entity Type:Organization
Organization Name:CASA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:LISSETT
Authorized Official - Last Name:CASAMALHUAPA CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-485-0470
Mailing Address - Street 1:14130 NOBLEWOOD PLZ
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1464
Mailing Address - Country:US
Mailing Address - Phone:703-485-0470
Mailing Address - Fax:703-986-0825
Practice Address - Street 1:14130 NOBLEWOOD PLZ
Practice Address - Street 2:SUITE 306
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1464
Practice Address - Country:US
Practice Address - Phone:703-485-0470
Practice Address - Fax:703-986-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208000000X
2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty