Provider Demographics
NPI:1821833799
Name:CASA WELLNESS
Entity type:Organization
Organization Name:CASA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-866-0963
Mailing Address - Street 1:14130 NOBLEWOOD PLZ STE 301
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1467
Mailing Address - Country:US
Mailing Address - Phone:703-485-0470
Mailing Address - Fax:703-986-0825
Practice Address - Street 1:14130 NOBLEWOOD PLZ STE 301
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1467
Practice Address - Country:US
Practice Address - Phone:703-485-0470
Practice Address - Fax:703-986-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics