Provider Demographics
NPI:1225396450
Name:SMITH, CASSANDRA (LVN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27212 CALAROGA AVE
Mailing Address - Street 2:HAYWARD
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4339
Mailing Address - Country:US
Mailing Address - Phone:510-785-5000
Mailing Address - Fax:
Practice Address - Street 1:4725 1ST ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7366
Practice Address - Country:US
Practice Address - Phone:925-417-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79143164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA79143OtherCA LICENSE