Healthcare Provider Details

I. General information

NPI: 1700251097
Provider Name (Legal Business Name): JOHN CASSONE PH.D, L.A.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28465 OLD TOWN FRONT ST SUITE 324
TEMECULA CA
92590-1819
US

IV. Provider business mailing address

28465 OLD TOWN FRONT ST SUITE 324
TEMECULA CA
92590-1819
US

V. Phone/Fax

Practice location:
  • Phone: 951-693-9355
  • Fax:
Mailing address:
  • Phone: 951-693-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 16743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: