Provider Demographics
NPI:1720039936
Name:CANSINO, CATHERINE DIANE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DIANE
Last Name:CANSINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y STREET, SUITE 2500
Mailing Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6900
Mailing Address - Fax:916-734-2158
Practice Address - Street 1:4860 Y STREET, SUITE 2500
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6900
Practice Address - Fax:916-734-2158
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64402207V00000X
NMMD20080671207V00000X
MDD0064402207V00000X
OH35095223207V00000X
CAC55562207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3044459Medicaid
OH4289131Medicare PIN
OH3044459Medicaid