Provider Demographics
NPI:1689066490
Name:CASCO, ALBA NIDIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ALBA
Middle Name:NIDIA
Last Name:CASCO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 3RD AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1353
Mailing Address - Country:US
Mailing Address - Phone:619-426-0100
Mailing Address - Fax:619-426-2170
Practice Address - Street 1:855 3RD AVE STE 2200
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1353
Practice Address - Country:US
Practice Address - Phone:619-426-0100
Practice Address - Fax:619-426-2170
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001957208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95001957OtherMEDICAL LIC