Provider Demographics
NPI:1033558556
Name:CASEY, TANYA
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:FAUCHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2821 OCEANSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4800
Mailing Address - Country:US
Mailing Address - Phone:760-721-2781
Mailing Address - Fax:
Practice Address - Street 1:2821 OCEANSIDE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4800
Practice Address - Country:US
Practice Address - Phone:760-721-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program