Provider Demographics
NPI:1174366587
Name:CASAL, CAROLINA MARIA (THW)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:MARIA
Last Name:CASAL
Suffix:
Gender:X
Credentials:THW
Other - Prefix:
Other - First Name:CARO
Other - Middle Name:MARIA
Other - Last Name:CASAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:THW
Mailing Address - Street 1:5415 SW WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2409
Mailing Address - Country:US
Mailing Address - Phone:305-978-4867
Mailing Address - Fax:
Practice Address - Street 1:5415 SW WESTGATE DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2409
Practice Address - Country:US
Practice Address - Phone:503-645-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist