1780667584 NPI number — KATHLEEN ANN CASS MD PHD

Table of content: DR. FRANK RESTIVO OD (NPI 1134643695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780667584 NPI number — KATHLEEN ANN CASS MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASS
Provider First Name:
KATHLEEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
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:
1780667584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3006 S MARYLAND PKWY
Provider Second Line Business Mailing Address:
SUITE 690 CHILDRENS HEART CENTER
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-732-1290
Provider Business Mailing Address Fax Number:
702-732-1385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3006 S MARYLAND PKWY
Provider Second Line Business Practice Location Address:
SUITE #690
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-732-1290
Provider Business Practice Location Address Fax Number:
702-732-1385
Provider Enumeration Date:
11/25/2005

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: 2080P0202X , with the licence number:  4793 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002002777 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: NV4793 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: VWCLCQ . This is a "MEDICARE GROUP #" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: XPY044330 . This is a "MEDI-CAL" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com