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
1	101YM0800X	Mental Health Counselor		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7184	OTHER	CA	MEDI-CAL
2	7667	OTHER	CA	MEDI-CAL
3	7708	OTHER	CA	MEDI-CAL
4	7368	OTHER	CA	MEDI-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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