Provider Demographics
NPI:1841085735
Name:CASAREZ, GENESHA
Entity type:Individual
Prefix:
First Name:GENESHA
Middle Name:
Last Name:CASAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10233 MISSION GORGE RD APT B107
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3042
Mailing Address - Country:US
Mailing Address - Phone:442-297-3704
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 85
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8822
Practice Address - Country:US
Practice Address - Phone:626-833-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB657011106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician