Healthcare Provider Details

I. General information

NPI: 1497371330
Provider Name (Legal Business Name): CASSIDY MAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 OCEAN RANCH BLVD STE 104
OCEANSIDE CA
92056-8601
US

IV. Provider business mailing address

2055 CHESTNUT AVE
CARLSBAD CA
92008-2716
US

V. Phone/Fax

Practice location:
  • Phone: 760-967-4401
  • Fax:
Mailing address:
  • Phone: 760-828-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95195994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: