Provider Demographics
NPI:1558736280
Name:CASAS, MARISSA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CASAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 E 8TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5883
Mailing Address - Country:US
Mailing Address - Phone:956-231-5541
Mailing Address - Fax:956-854-4245
Practice Address - Street 1:6900 N 10TH ST STE NO4
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3198
Practice Address - Country:US
Practice Address - Phone:956-627-5137
Practice Address - Fax:956-720-0966
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12876111N00000X
TXPA13525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor