Provider Demographics
NPI:1184770695
Name:SPALDING-DIAS, CASSIE JUSTINE (MD)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:JUSTINE
Last Name:SPALDING-DIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:JUSTINE
Other - Last Name:SPALDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-0960
Mailing Address - Country:US
Mailing Address - Phone:916-642-9077
Mailing Address - Fax:
Practice Address - Street 1:7150 SIERRA PONDS LN
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-7346
Practice Address - Country:US
Practice Address - Phone:916-772-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA976612081P0301X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine