Healthcare Provider Details

I. General information

NPI: 1225725922
Provider Name (Legal Business Name): CAMERON RAY CASSIDY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WASHINGTON ST
SAN DIEGO CA
92103-2289
US

IV. Provider business mailing address

10144 MARCELLA CT
SANTEE CA
92071-1062
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-8300
  • Fax:
Mailing address:
  • Phone: 619-252-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: