Healthcare Provider Details

I. General information

NPI: 1487924510
Provider Name (Legal Business Name): KASSANDRA LEI MACPHERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41715 WINCHESTER RD STE 101
TEMECULA CA
92590-4853
US

IV. Provider business mailing address

109 S LAS POSAS RD STE 101
SAN MARCOS CA
92078-2419
US

V. Phone/Fax

Practice location:
  • Phone: 951-308-4451
  • Fax:
Mailing address:
  • Phone: 442-325-3354
  • Fax: 760-205-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21060
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: