Provider Demographics
NPI:1487906137
Name:CASAS, DORA LETICIA
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:LETICIA
Last Name:CASAS
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 1:412 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4969
Mailing Address - Country:US
Mailing Address - Phone:361-227-4355
Mailing Address - Fax:
Practice Address - Street 1:412 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4969
Practice Address - Country:US
Practice Address - Phone:361-227-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies