Provider Demographics
NPI:1790436152
Name:ABELAR, CASSANDRA JUSTINE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JUSTINE
Last Name:ABELAR
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 1:14109 DARTMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3539
Mailing Address - Country:US
Mailing Address - Phone:714-222-2262
Mailing Address - Fax:
Practice Address - Street 1:14109 DARTMOUTH CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3539
Practice Address - Country:US
Practice Address - Phone:714-222-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty