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General NPI Number Information
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NPI Number | 1366716649
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Entity Type | Individual
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Provider Name | CASSIDY V GAGNON
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Gender | Female
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Dates
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Enumeration Date | 03/03/2012
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 7601 STONERIDGE DR
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City | PLEASANTON
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State | CA
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Zip | 94588-4501
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Country | US
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Telephone | 385-841-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 8262 N LAKE DR APT C
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City | DUBLIN
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State | CA
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Zip | 94568-3784
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A137759
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License Number State | CA
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