Provider Demographics
NPI:1467977363
Name:TUMANUVAO, CASSANDRA NICOLE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:NICOLE
Last Name:TUMANUVAO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 S SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3346
Mailing Address - Country:US
Mailing Address - Phone:714-400-1507
Mailing Address - Fax:
Practice Address - Street 1:4343 VON KARMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2098
Practice Address - Country:US
Practice Address - Phone:949-650-4334
Practice Address - Fax:949-548-4718
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96302106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14006636OtherCAQH