Healthcare Provider Details

I. General information

NPI: 1093767782
Provider Name (Legal Business Name): CASSANDRA A MAHAN-RICHARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 MOUNT VERNON AVE
GRAND TERRACE CA
92313-5172
US

IV. Provider business mailing address

PO BOX 3649
SPOKANE WA
99220-3649
US

V. Phone/Fax

Practice location:
  • Phone: 909-864-1097
  • Fax: 951-225-6879
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG53986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG53986
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD60286895
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: