Provider Demographics
NPI:1013493154
Name:COLLET, CASEY ANN (MD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:ANN
Last Name:COLLET
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 1:1537 NORFOLK ST STE 5800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1537 NORFOLK ST STE 5800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1023
Practice Address - Country:US
Practice Address - Phone:323-442-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2024-06-06
Deactivation Date:2024-03-18
Deactivation Code:
Reactivation Date:2024-05-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program