Provider Demographics
NPI:1942231618
Name:CASA VERDE PEDIATRICS, INC
Entity Type:Organization
Organization Name:CASA VERDE PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-939-7334
Mailing Address - Street 1:301 LENNON LN STE 203
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2483
Mailing Address - Country:US
Mailing Address - Phone:925-939-7334
Mailing Address - Fax:925-939-7340
Practice Address - Street 1:301 LENNON LN STE 203
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2483
Practice Address - Country:US
Practice Address - Phone:925-939-7334
Practice Address - Fax:925-939-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083245208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2174226Medicaid