Provider Demographics
NPI:1629561154
Name:BURRUEL, CASSANDRA LAUREN
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LAUREN
Last Name:BURRUEL
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 1:13755 N LITCHFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4288
Mailing Address - Country:US
Mailing Address - Phone:623-322-5900
Mailing Address - Fax:
Practice Address - Street 1:13755 N LITCHFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-322-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant