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General NPI Number Information
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NPI Number | 1932758091
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Entity Type | Individual
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Provider Name | CASSANDRA SALARIA DEOCERA PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 100 W DEAN KEETON ST
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City | AUSTIN
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State | TX
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Zip | 78712-1091
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Country | US
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Telephone | 512-475-8242
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Fax | 512-232-7552
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Provider Business Mailing Address
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Address Line | 3218 GONZALES ST APT 1216
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City | AUSTIN
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State | TX
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Zip | 78702-3838
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Country | US
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Telephone | 732-598-1899
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00536200
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License Number State | NJ
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