Provider Demographics
NPI:1275946030
Name:DELEONGUERRERO, CASEY (DO)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:DELEONGUERRERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-522-9400
Mailing Address - Fax:928-774-4808
Practice Address - Street 1:2920 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-522-9400
Practice Address - Fax:928-774-4808
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007888207V00000X
PAOS019222207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology