Provider Demographics
NPI:1790014389
Name:KNIGHT, CASSANDRA D (LMT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:D
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 W 210TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1626
Mailing Address - Country:US
Mailing Address - Phone:360-970-7749
Mailing Address - Fax:
Practice Address - Street 1:2126 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5705
Practice Address - Country:US
Practice Address - Phone:562-439-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist