Provider Demographics
NPI:1467666164
Name:CASUCCI, JOSEPH ANTHONY
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:CASUCCI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6208
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6208
Mailing Address - Country:US
Mailing Address - Phone:707-443-5100
Mailing Address - Fax:707-268-8830
Practice Address - Street 1:539 G ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1030
Practice Address - Country:US
Practice Address - Phone:707-443-5100
Practice Address - Fax:707-268-8830
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies