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General NPI Number Information
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NPI Number | 1417503731
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Entity Type | Individual
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Provider Name | CASSANDRA K GARDUNO MA
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Gender | Female
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 4160 TEMESCAL CANYON RD STE 309
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City | CORONA
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State | CA
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Zip | 92883-4629
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Country | US
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Telephone | 951-283-9611
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Fax |
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Provider Business Mailing Address
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Address Line | 15158 BIARRITZ ST
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-7106
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Country | US
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Telephone | 951-283-9611
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 114009
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License Number State | CA
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