Healthcare Provider Details

I. General information

NPI: 1801658091
Provider Name (Legal Business Name): CASSANDRA E CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E HUNTINGTON DR
ARCADIA CA
91006-3731
US

IV. Provider business mailing address

207 S LOUISE AVE
AZUSA CA
91702-4348
US

V. Phone/Fax

Practice location:
  • Phone: 626-888-1773
  • Fax:
Mailing address:
  • Phone: 909-541-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number28294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: