Provider Demographics
NPI:1407822141
Name:CASO, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:CASO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24541 PACIFIC PARK DR
Mailing Address - Street 2:#109
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3065
Mailing Address - Country:US
Mailing Address - Phone:949-362-1212
Mailing Address - Fax:949-362-4755
Practice Address - Street 1:24541 PACIFIC PARK DR
Practice Address - Street 2:#109
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3065
Practice Address - Country:US
Practice Address - Phone:949-362-1212
Practice Address - Fax:949-362-4755
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30460207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44433Medicare UPIN
CAW13094Medicare ID - Type Unspecified