Provider Demographics
NPI:1538501705
Name:MAJESTIC, CASSONDRA LOMELI (MD)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:LOMELI
Last Name:MAJESTIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 THE CITY DR S
Mailing Address - Street 2:BLDG 200, SUITE 710, RT 128-01
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-5922
Mailing Address - Fax:714-456-3714
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BLDG 200, SUITE 710, RT 128-01
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-5922
Practice Address - Fax:714-456-3714
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA136050207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program