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Individual

CASEY CACCAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
14850 ROSCOE BLVD, PANORAMA CITY, CA 91402-4618
(818) 904-3122
Mailing address
2334 ROWLAND AVE, SIMI VALLEY, CA 93063-3050
(805) 657-7997

Taxonomy

Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
95163263
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95136263
RN
CA
Enumeration date
10/28/2019
Last updated
10/28/2019
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