Provider Demographics
NPI:1477448199
Name:THOMPSON, CASSANDRA MEDINA
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MEDINA
Last Name:THOMPSON
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 1:208 TRIPLE BEND DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5940
Mailing Address - Country:US
Mailing Address - Phone:210-382-0157
Mailing Address - Fax:
Practice Address - Street 1:101 WOODBRIDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-0109
Practice Address - Country:US
Practice Address - Phone:830-581-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1204158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty