Provider Demographics
NPI:1639462930
Name:VILLATORO-BANK, CASSANDRA (DO)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:VILLATORO-BANK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:602-470-5043
Mailing Address - Fax:602-470-5064
Practice Address - Street 1:3141 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4360
Practice Address - Country:US
Practice Address - Phone:602-914-1520
Practice Address - Fax:602-468-4512
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR19062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry