Provider Demographics
NPI:1245765973
Name:GARCIA, CASSANDRA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:GARCIA
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 1:4076 JACKSON AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3242
Mailing Address - Country:US
Mailing Address - Phone:310-625-3574
Mailing Address - Fax:
Practice Address - Street 1:4076 JACKSON AVE
Practice Address - Street 2:APT 3
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3242
Practice Address - Country:US
Practice Address - Phone:310-625-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer