Provider Demographics
NPI:1710214085
Name:CASSIDY, PAOLA L
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:L
Last Name:CASSIDY
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 1:4101 EASTON DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1021
Mailing Address - Country:US
Mailing Address - Phone:661-377-1700
Mailing Address - Fax:661-377-1707
Practice Address - Street 1:4101 EASTON DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1021
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:661-377-1707
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist