Provider Demographics
NPI:1982256962
Name:TAYLOR, CASSANDRA LEA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEA
Last Name:TAYLOR
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 1:5445 PRINCE EDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-3409
Mailing Address - Country:US
Mailing Address - Phone:915-219-2802
Mailing Address - Fax:
Practice Address - Street 1:5445 PRINCE EDWARD AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-3409
Practice Address - Country:US
Practice Address - Phone:915-219-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide