Provider Demographics
NPI:1376029934
Name:ATLAS, CASSANDRA VICTORIA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:VICTORIA
Last Name:ATLAS
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 1:41770 MARGARITA RD APT 2025
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1969
Mailing Address - Country:US
Mailing Address - Phone:951-973-9473
Mailing Address - Fax:
Practice Address - Street 1:4001 11TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3501
Practice Address - Country:US
Practice Address - Phone:951-346-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst