Individual
CASEY T DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18646 OXNARD ST TARZANA, CA 91356, TARZANA, CA 91356
(818) 996-1051
Mailing address
6842 MCLENNAN AVE, LAKE BALBOA, CA 91406-4529
(702) 539-6560
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-XZYKQV
CA
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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