Provider Demographics
NPI:1922328871
Name:ENGMARK, CASEY JEE
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JEE
Last Name:ENGMARK
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 1:2818 I ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4364
Mailing Address - Country:US
Mailing Address - Phone:916-214-5879
Mailing Address - Fax:
Practice Address - Street 1:2230 9TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1310
Practice Address - Country:US
Practice Address - Phone:916-448-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging