Provider Demographics
NPI:1790460715
Name:CASSIBBA, KATELYN ELIZABETH-TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELIZABETH-TAYLOR
Last Name:CASSIBBA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1156 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5715
Mailing Address - Country:US
Mailing Address - Phone:831-899-8100
Mailing Address - Fax:
Practice Address - Street 1:1156 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5715
Practice Address - Country:US
Practice Address - Phone:831-899-8100
Practice Address - Fax:831-899-8105
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant