Provider Demographics
NPI:1346823549
Name:HAMLER, CASSY
Entity Type:Individual
Prefix:
First Name:CASSY
Middle Name:
Last Name:HAMLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASSIEY
Other - Middle Name:
Other - Last Name:HAMLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8414 S FIGUEROA ST APT 12
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-2757
Mailing Address - Country:US
Mailing Address - Phone:323-884-0030
Mailing Address - Fax:
Practice Address - Street 1:8414 S FIGUEROA ST APT 12
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-2757
Practice Address - Country:US
Practice Address - Phone:323-884-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6360819405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020575571Medicaid