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General NPI Number Information
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NPI Number | 1306472410
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Entity Type | Individual
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Provider Name | CASSANDRA LIZAOLA RADT-1
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Gender | Female
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 30500 ARRASTRE CANYON RD
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City | ACTON
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State | CA
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Zip | 93510-2160
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Country | US
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Telephone | 661-223-8825
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1534
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City | LEBEC
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State | CA
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Zip | 93243-1534
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Country | US
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Telephone | 661-231-5413
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number | R1317730818
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License Number State | CA
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