Provider Demographics
NPI:1396912762
Name:MASAJO, ALELI CASINO (MD)
Entity type:Individual
Prefix:DR
First Name:ALELI
Middle Name:CASINO
Last Name:MASAJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2148 JACKSON KELLER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2722
Mailing Address - Country:US
Mailing Address - Phone:210-501-0703
Mailing Address - Fax:210-526-0334
Practice Address - Street 1:2148 JACKSON KELLER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2722
Practice Address - Country:US
Practice Address - Phone:210-501-0703
Practice Address - Fax:210-526-0334
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314373702Medicaid