Healthcare Provider Details

I. General information

NPI: 1356457170
Provider Name (Legal Business Name): CASSANDRA OHLSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 14TH ST
PACIFIC GROVE CA
93950-2725
US

IV. Provider business mailing address

PO BOX 51520
PACIFIC GROVE CA
93950-6520
US

V. Phone/Fax

Practice location:
  • Phone: 831-277-2220
  • Fax:
Mailing address:
  • Phone: 831-277-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG56448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: