Provider Demographics
NPI:1841965076
Name:BURSMA, CASSANDRA M
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:M
Last Name:BURSMA
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 1:350 S JACKSON ST APT 450
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3362
Mailing Address - Country:US
Mailing Address - Phone:978-494-2220
Mailing Address - Fax:
Practice Address - Street 1:611 WILSHIRE BLVD STE 1002
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2906
Practice Address - Country:US
Practice Address - Phone:213-373-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86015510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered