Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | G53986 | CA |
Y | 207KA0200X | Allergist | MD60286895 | WA |
NPI | 1093767782 |
---|---|
Provider Name | Dr. Cassandra A Mahan-Richards |
First Address | Spokane, WA 99220-3649 |
Second Address | Grand Terrace, CA 92313-5172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G646250 | (05) | CA |
AM3225314 | DEA NUMBER (01) | CA |
F38084 | (02) | CA |
MD60286895 | WASHINGTON STATE LICENSE (01) | WA |