Provider Demographics
NPI:1972880144
Name:ZGLICZYNSKI, CASSANDRA RENEE (RN,PHN)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:RENEE
Last Name:ZGLICZYNSKI
Suffix:
Gender:F
Credentials:RN,PHN
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:RENEE
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,PHN
Mailing Address - Street 1:3609 OCEAN RANCH BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056
Mailing Address - Country:US
Mailing Address - Phone:760-967-4401
Mailing Address - Fax:760-967-4644
Practice Address - Street 1:1029 EMERALD ST APT C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2816
Practice Address - Country:US
Practice Address - Phone:619-952-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA770296163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn