Provider Demographics
NPI:1831678572
Name:DE LOS ANGELES, CASSIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:
Last Name:DE LOS ANGELES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1027 N HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3412
Mailing Address - Country:US
Mailing Address - Phone:407-759-8683
Mailing Address - Fax:
Practice Address - Street 1:7560 RED BUG LAKE RD STE 1014
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6591
Practice Address - Country:US
Practice Address - Phone:407-759-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111460363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical