Provider Demographics
NPI:1275119349
Name:CASS, JOAN (BCHN CAND CTNC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:CASS
Suffix:
Gender:F
Credentials:BCHN CAND CTNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22252 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2307
Mailing Address - Country:US
Mailing Address - Phone:818-590-1159
Mailing Address - Fax:818-347-9331
Practice Address - Street 1:22252 BASSETT ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2307
Practice Address - Country:US
Practice Address - Phone:818-590-1159
Practice Address - Fax:818-347-9331
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0003121628-0001-1133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education