Provider Demographics
NPI:1093189565
Name:MARTIN, CASSANDRA E (CSFA/CST)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CSFA/CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 PANTHERWAY
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8260
Mailing Address - Country:US
Mailing Address - Phone:254-447-0417
Mailing Address - Fax:
Practice Address - Street 1:10604 PANTHERWAY
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8260
Practice Address - Country:US
Practice Address - Phone:254-447-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant