Provider Demographics
NPI:1528140209
Name:CASIANO, RAYETTE POLLARD (MD)
Entity type:Individual
Prefix:
First Name:RAYETTE
Middle Name:POLLARD
Last Name:CASIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-7000
Mailing Address - Country:US
Mailing Address - Phone:602-325-5580
Mailing Address - Fax:
Practice Address - Street 1:6611 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-7000
Practice Address - Country:US
Practice Address - Phone:602-325-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130CCMedicaid
AK1599671Medicaid
NC2295206Medicare ID - Type Unspecified
NC89130CCMedicaid