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NPI Code Detail

MEDICARE: CASSONDRA E. SANDERS MFT I

MEDICARE:   CASSONDRA E. SANDERS  MFT I
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
1101YM0800XMental Health CounselorCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17184OTHERCAMEDI-CAL
27667OTHERCAMEDI-CAL
37708OTHERCAMEDI-CAL
47368OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1619241957
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSONDRA E. SANDERS MFT I
Provider Business Mailing Address
First Line : 3359 CHICAGO AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-6820
Country : US
Telephone Number : 951-900-4414
Fax Number : 951-880-0817
Provider Business Practice Location Address
First Line : 29970 TECHNOLOGY DR STE E123
Second Line :
City : MURRIETA
State : CA
Zip : 92563
Country : US
Telephone Number : 951-900-4414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2012
Last Update Date : 07/23/2018

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Directions to “ CASSONDRA E. SANDERS MFT I” Practice Location

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