Provider Demographics
NPI:1861102394
Name:SCOTT-DEEB, CASEY (LAC)
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:
Last Name:SCOTT-DEEB
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 LANTANA ST APT 85
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6106
Mailing Address - Country:US
Mailing Address - Phone:619-301-1879
Mailing Address - Fax:805-384-0220
Practice Address - Street 1:2370 LAS POSAS RD STE B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3444
Practice Address - Country:US
Practice Address - Phone:619-301-1879
Practice Address - Fax:805-384-0220
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18516171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty