Healthcare Provider Details

I. General information

NPI: 1881842599
Provider Name (Legal Business Name): MRS. CASSANDRA RENEE SULFRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 POTRERO AVE L-UNIT
SAN FRANCISCO CA
94110-2869
US

IV. Provider business mailing address

2275 ARLINGTON DR
SAN LEANDRO CA
94578-1132
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-6346
  • Fax: 415-206-6469
Mailing address:
  • Phone: 510-317-1437
  • Fax: 510-276-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: