MEDICARE: CASSANDRA KARI FELICIANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA65329	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA65329	OTHER	CA	PHYSICIAN ASSISTANT BOARD OF CALIFORNIA

General Provider Information

NPI Number	:	1134956816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA KARI FELICIANO

Provider Business Mailing Address
First Line	:	29826 HAUN RD STE 314
Second Line	:
City	:	MENIFEE
State	:	CA
Zip	:	92586-6546
Country	:	US
Telephone Number	:	951-381-8150
Fax Number	:

Provider Business Practice Location Address
First Line	:	29826 HAUN RD STE 314
Second Line	:
City	:	MENIFEE
State	:	CA
Zip	:	92586-6546
Country	:	US
Telephone Number	:	951-381-8150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	05/27/2026

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Directions to “ CASSANDRA KARI FELICIANO ” Practice Location

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