Provider Demographics
NPI:1699410480
Name:ANDERTON, CASEY MICHELL
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MICHELL
Last Name:ANDERTON
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 1:1165 N 7TH PL
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2539
Mailing Address - Country:US
Mailing Address - Phone:805-645-0370
Mailing Address - Fax:
Practice Address - Street 1:3400 LOMA VISTA RD STE 7
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3057
Practice Address - Country:US
Practice Address - Phone:805-645-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory