Provider Demographics
NPI:1265742530
Name:MOORE, CASSANDRA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MOORE
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:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:GRIZZY FLATS
Mailing Address - State:CA
Mailing Address - Zip Code:95636
Mailing Address - Country:US
Mailing Address - Phone:530-621-9800
Mailing Address - Fax:530-621-9804
Practice Address - Street 1:768 PLEASANT VALLEY RD
Practice Address - Street 2:STE 304
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619
Practice Address - Country:US
Practice Address - Phone:530-621-9800
Practice Address - Fax:530-621-9804
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator