Healthcare Provider Details

I. General information

NPI: 1235708066
Provider Name (Legal Business Name): KASANDRA NICOLE PADRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date: 06/29/2023
Reactivation Date: 08/07/2023

III. Provider practice location address

930 F ST
WASCO CA
93280-2040
US

IV. Provider business mailing address

930 F ST
WASCO CA
93280-2040
US

V. Phone/Fax

Practice location:
  • Phone: 661-674-3377
  • Fax:
Mailing address:
  • Phone: 661-674-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: