Provider Demographics
NPI:1063098895
Name:PAREDES-AGUILAR, CASSANDRA GUADALUPE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:GUADALUPE
Last Name:PAREDES-AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:GUADALUPE
Other - Last Name:PAREDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:384 TREELINE PARK APT 1911
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1862
Mailing Address - Country:US
Mailing Address - Phone:956-346-2420
Mailing Address - Fax:
Practice Address - Street 1:384 TREELINE PARK APT 1911
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1862
Practice Address - Country:US
Practice Address - Phone:956-346-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35773183700000X
183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician