Healthcare Provider Details

I. General information

NPI: 1568056539
Provider Name (Legal Business Name): CASSANDRA REBECCA RUDE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9813 CASPI GARDENS DR UNIT 7
SANTEE CA
92071-1832
US

IV. Provider business mailing address

9813 CASPI GARDENS DR UNIT 7
SANTEE CA
92071-1832
US

V. Phone/Fax

Practice location:
  • Phone: 360-317-4596
  • Fax:
Mailing address:
  • Phone: 360-317-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: