Healthcare Provider Details

I. General information

NPI: 1730473596
Provider Name (Legal Business Name): MS. CASSANDRA GATLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 EDISON AVE
SACRAMENTO CA
95821-2462
US

IV. Provider business mailing address

9343 TECH CENTER DR
SACRAMENTO CA
95826-2563
US

V. Phone/Fax

Practice location:
  • Phone: 279-300-8404
  • Fax:
Mailing address:
  • Phone: 279-300-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: