Provider Demographics
NPI:1265565725
Name:CASERIO, MARIE JOSEPHINE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JOSEPHINE
Last Name:CASERIO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 PARK NEWPORT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5035
Mailing Address - Country:US
Mailing Address - Phone:949-640-2693
Mailing Address - Fax:
Practice Address - Street 1:13440 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4820
Practice Address - Country:US
Practice Address - Phone:562-926-3440
Practice Address - Fax:562-926-0678
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11896363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical