Provider Demographics
NPI:1679758585
Name:CASSIDENTI & ASSOCIATES, INC
Entity Type:Organization
Organization Name:CASSIDENTI & ASSOCIATES, INC
Other - Org Name:CASSIDENTI & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASSIDENTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-2344
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:#560
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4223
Mailing Address - Country:US
Mailing Address - Phone:714-835-0101
Mailing Address - Fax:714-835-1133
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:#560
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4223
Practice Address - Country:US
Practice Address - Phone:714-835-0101
Practice Address - Fax:714-835-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE58956Medicare UPIN