Provider Demographics
NPI:1669235479
Name:GO, DEXLIER CASAS
Entity type:Individual
Prefix:
First Name:DEXLIER
Middle Name:CASAS
Last Name:GO
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 1:8729 EAGLES ROOST RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-9214
Mailing Address - Country:US
Mailing Address - Phone:831-228-1207
Mailing Address - Fax:831-851-0080
Practice Address - Street 1:591 ARLENE DR
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3518
Practice Address - Country:US
Practice Address - Phone:831-228-1207
Practice Address - Fax:831-851-0080
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445202878310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility