1023415726 NPI number — CASSANDRA DORAME

Table of content: CASSANDRA DORAME (NPI 1023415726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023415726 NPI number — CASSANDRA DORAME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORAME
Provider First Name:
CASSANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023415726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 E RAY RD STE 4A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85225-1777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-659-2000
Provider Business Mailing Address Fax Number:
480-659-3201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 E HUNT HWY STE A-2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN TAN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85143-4962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-882-2222
Provider Business Practice Location Address Fax Number:
480-882-2220
Provider Enumeration Date:
11/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  5940 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)