MEDICARE: CASSANDRA TESIK BA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	172V00000X	Community Health Worker
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1740993039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA TESIK BA

Provider Business Mailing Address
First Line	:	8945 GOLF LINKS RD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-4124
Country	:	US
Telephone Number	:
Fax Number	:	866-500-2186

Provider Business Practice Location Address
First Line	:	1658 GLENVILLE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3807
Country	:	US
Telephone Number	:	408-460-3878
Fax Number	:

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

Provider Enumeration Date	:	01/02/2023
Last Update Date	:	06/22/2023

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