Healthcare Provider Details

I. General information

NPI: 1295089837
Provider Name (Legal Business Name): CASSANDRA WHITTINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 KERNER BLVD STE A
SAN RAFAEL CA
94901-4840
US

IV. Provider business mailing address

155 WAILEA IKE PL APT 14
KIHEI HI
96753-9565
US

V. Phone/Fax

Practice location:
  • Phone: 415-456-9350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number13500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: