Most Relevant Information
Provider Data
| NPI Number: | 1003311747 |
| Provider Name: | CASEY DISTASO MD |
| Entity Type: | Individual |
| Taxonomy Code: | 207P00000X |
| Specialty: | Emergency Medicine |
| License Number: | 62985 |
Most Important Dates
| Enumeration Date: | 03/26/2018 |
| Last Updated: | 06/07/2024 |
Provider Practice Location
8700 BEVERLY BLVD
WEST HOLLYWOOD
CA
900481804
Practice Location Phone/Fax
| Phone: | 3104238780 |
| Fax: |
Provider Mailing Location
4140 W 190TH ST
TORRANCE
CA
905045513
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |