Individual
BERENICE CONCEPCION CASAVANTES SIAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 S HALE AVE SPC 54, ESCONDIDO, CA 92029-2177
(858) 729-8295
Mailing address
874 ADA ST # 1, CHULA VISTA, CA 91911-2636
(619) 735-0864
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y9698802
CALIFORNIA IDENTIFICATION CARD
CA
Enumeration date
08/09/2024
Last updated
08/09/2024
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