Provider Information for 1700087277
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CAROLE A CASSIDY
Sex: Female
NPI: 1700087277
Last Updated: 2024-06-04
Certification Date: 2024-05-31
Certification Date: 2024-05-31
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1700087277 | ||||||||
| Enumeration Date | 2007-05-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 103 G ST PETALUMA, CA 94952-4239 United States Phone: 650-279-3766 | Fax: | ||||||||
| Primary Practice Address | 103 G ST PETALUMA, CA 94952-4239 United States Phone: 650-279-3766 | Fax: | ||||||||
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