Provider Demographics
NPI:1174254759
Name:GARCIA-GIRON, KASSANDRA NAHOMY
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:NAHOMY
Last Name:GARCIA-GIRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 OGG AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-2824
Mailing Address - Country:US
Mailing Address - Phone:856-383-4408
Mailing Address - Fax:
Practice Address - Street 1:128 OGG AVE
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-2824
Practice Address - Country:US
Practice Address - Phone:856-383-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG05544267552012OtherDRIVERS LICENSE