Provider Demographics
NPI:1134640154
Name:CEREMUGA, CASSANDRA (DO)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:CEREMUGA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 MAE ANNE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-4718
Mailing Address - Country:US
Mailing Address - Phone:775-624-6350
Mailing Address - Fax:
Practice Address - Street 1:6350 MAE ANNE AVE STE 3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-4718
Practice Address - Country:US
Practice Address - Phone:775-624-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVDO2795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program