Provider Demographics
NPI:1689383580
Name:BELTZ, KASSANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:BELTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KASSANDRA
Other - Middle Name:
Other - Last Name:BELTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KASSANDRA RAYGOZA
Mailing Address - Street 1:221 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:JBSA RANDOLPH
Mailing Address - State:TX
Mailing Address - Zip Code:78150-4800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 3RD ST W
Practice Address - Street 2:
Practice Address - City:JBSA RANDOLPH
Practice Address - State:TX
Practice Address - Zip Code:78150-4800
Practice Address - Country:US
Practice Address - Phone:210-652-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant