MEDICARE: CASSANDRA DE ANDA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1619340841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA DE ANDA

Provider Business Mailing Address
First Line	:	3540 GREENVEIL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-0383
Country	:	US
Telephone Number	:	915-319-8553
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 GREENVEIL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-0383
Country	:	US
Telephone Number	:	915-319-8553
Fax Number	:

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	11/10/2015

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Directions to “ CASSANDRA DE ANDA ” Practice Location

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