Provider Demographics
NPI:1194106765
Name:ESPINOZA, CASSANDRA (LMP)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 NE 79TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4465
Mailing Address - Country:US
Mailing Address - Phone:425-861-3832
Mailing Address - Fax:425-861-3808
Practice Address - Street 1:16700 NE 79TH ST
Practice Address - Street 2:STE 101
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4465
Practice Address - Country:US
Practice Address - Phone:425-861-3832
Practice Address - Fax:425-861-3808
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60531428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60531428OtherLICENSE