Provider Demographics
NPI:1952755803
Name:CORSINO, CASEY DAWN-MARIE (DO)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:DAWN-MARIE
Last Name:CORSINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:DAWN-MARIE
Other - Last Name:BJELLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1278 E LATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4445
Mailing Address - Country:US
Mailing Address - Phone:951-925-6625
Mailing Address - Fax:
Practice Address - Street 1:1278 E LATHAM AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4445
Practice Address - Country:US
Practice Address - Phone:951-925-6625
Practice Address - Fax:888-702-6846
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15817207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty