Provider Demographics
NPI:1275691669
Name:CASCO, ANN M (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:M
Last Name:CASCO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 CURIE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4109
Mailing Address - Country:US
Mailing Address - Phone:619-206-9679
Mailing Address - Fax:858-638-7769
Practice Address - Street 1:16885 W BERNARDO DR
Practice Address - Street 2:SUITE 380A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1618
Practice Address - Country:US
Practice Address - Phone:619-206-9679
Practice Address - Fax:858-638-7769
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8847208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice