Provider Demographics
NPI:1366078891
Name:CARIDAD, CASEY CAMILA
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:CAMILA
Last Name:CARIDAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 STABLE STONE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-6540
Mailing Address - Country:US
Mailing Address - Phone:281-908-7060
Mailing Address - Fax:
Practice Address - Street 1:1912 STABLE STONE LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-6540
Practice Address - Country:US
Practice Address - Phone:281-908-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer