Provider Demographics
NPI:1336473966
Name:CASADO SASTRE DE GALLI, CONCEPCION ANA (RMA,ONDAMED CERT)
Entity Type:Individual
Prefix:MRS
First Name:CONCEPCION
Middle Name:ANA
Last Name:CASADO SASTRE DE GALLI
Suffix:
Gender:F
Credentials:RMA,ONDAMED CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 JUNCO LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4742
Mailing Address - Country:US
Mailing Address - Phone:865-966-2203
Mailing Address - Fax:865-966-2203
Practice Address - Street 1:151 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2347
Practice Address - Country:US
Practice Address - Phone:865-556-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R.M.A. 295007247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other