Individual
CASEY DISTASO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8700 BEVERLY BLVD, WEST HOLLYWOOD, CA 90048-1804
(310) 423-8780
Mailing address
4140 W 190TH ST, TORRANCE, CA 90504-5513
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
125.072192
IL
207P00000X
Emergency Medicine Physician
62985
TN
207P00000X
Emergency Medicine Physician
Primary
A196321
CA
2083C0008X
Clinical Informatics Physician
A196321
CA
Other
Enumeration date
03/26/2018
Last updated
06/07/2024
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