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1417635905
CASEY T DOHERTY
TARZANA, CA
NPI
1417635905
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
(Licence: CA MPSS-XZYKQV)
Enumeration Date
2023-07-06
Last Update Date
2023-07-06
Business Address
CASEY T DOHERTY
18646 OXNARD ST TARZANA, CA 91356
TARZANA, CA 91356
Phone number: 818-996-1051
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Mailing Address
CASEY T DOHERTY
6842 MCLENNAN AVE
LAKE BALBOA, CA 91406-4529
Phone number: 702-539-6560
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