Provider Demographics
NPI:1992782148
Name:CASAREZ, TIMOTHY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:CASAREZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:SUITE 202 PEDIATRIC CARDIOLOGY MED ASSOC OF SO CAL
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1502
Mailing Address - Country:US
Mailing Address - Phone:818-784-6269
Mailing Address - Fax:818-784-1531
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:SUITE 202 PEDIATRIC CARDIOLOGY MED ASSOC OF SO CAL
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1502
Practice Address - Country:US
Practice Address - Phone:818-784-6269
Practice Address - Fax:818-784-1531
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-11-30
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Provider Licenses
StateLicense IDTaxonomies
CAA733012080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2703831Medicare UPIN