Healthcare Provider Details

I. General information

NPI: 1033761689
Provider Name (Legal Business Name): CASSANDRA SOARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 09/22/2023
Certification Date: 05/07/2020
Deactivation Date: 05/07/2020
Reactivation Date: 09/22/2023

III. Provider practice location address

777 AUDITORIUM DR
REDDING CA
96001-0920
US

IV. Provider business mailing address

2183 PRINCETON WAY
REDDING CA
96003-8239
US

V. Phone/Fax

Practice location:
  • Phone: 530-592-7010
  • Fax:
Mailing address:
  • Phone: 530-592-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License NumberY6974382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: