Provider Demographics
NPI:1427234400
Name:CASCONE, NICHOLAS JAMES JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:CASCONE
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11935 KLING ST APT 18
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4044
Mailing Address - Country:US
Mailing Address - Phone:818-636-8074
Mailing Address - Fax:
Practice Address - Street 1:11935 KLING ST APT 18
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4044
Practice Address - Country:US
Practice Address - Phone:818-636-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant