Healthcare Provider Details

I. General information

NPI: 1750294484
Provider Name (Legal Business Name): CASSIDY MARIE PARKER SFIDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 FARENHOLT RD
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

14301 FARENHOLT RD
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 317-701-4992
  • Fax:
Mailing address:
  • Phone: 317-701-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: