Healthcare Provider Details

I. General information

NPI: 1053921569
Provider Name (Legal Business Name): ASHA RACHEL ELLMAN-KASSING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHA RACHEL KASSING

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 FREEPORT BLVD # 427
SACRAMENTO CA
95818-4346
US

IV. Provider business mailing address

3053 FREEPORT BLVD # 427
SACRAMENTO CA
95818-4346
US

V. Phone/Fax

Practice location:
  • Phone: 916-595-0007
  • Fax:
Mailing address:
  • Phone: 916-595-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: