Provider Demographics
NPI: | 1275318099 |
---|---|
Name: | CASSANDRE CASSEUS CRNA |
Entity Type: | Organization |
Organization Name: | CASSANDRE CASSEUS CRNA |
Other - Org Name: | CASSANDRE RIBEIRO |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CASSANDRE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CASSEUS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CRNA |
Authorized Official - Phone: | 917-297-5421 |
Mailing Address - Street 1: | PO BOX 7001 |
Mailing Address - Street 2: | |
Mailing Address - City: | TARZANA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91357-7001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 818-888-7815 |
Mailing Address - Fax: | 818-715-1722 |
Practice Address - Street 1: | 6815 NOBLE AVE |
Practice Address - Street 2: | |
Practice Address - City: | VAN NUYS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91405-3796 |
Practice Address - Country: | US |
Practice Address - Phone: | 818-901-6600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-08-29 |
Last Update Date: | 2023-10-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Single Specialty |