Provider Demographics
NPI:1982146338
Name:SCALES, CARESSA
Entity Type:Individual
Prefix:
First Name:CARESSA
Middle Name:
Last Name:SCALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DAWN
Other - Last Name:SEALS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2716 EAST PONTIAC WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-5684
Mailing Address - Country:US
Mailing Address - Phone:559-724-9946
Mailing Address - Fax:
Practice Address - Street 1:2716 E PONTIAC WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4928
Practice Address - Country:US
Practice Address - Phone:559-724-9946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant