Healthcare Provider Details

I. General information

NPI: 1720266463
Provider Name (Legal Business Name): CASSANDRA ELAINE BUEHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA HEREDIA

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

IV. Provider business mailing address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-9392
  • Fax:
Mailing address:
  • Phone: 562-981-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT114653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: