Provider Demographics
NPI:1437810611
Name:VALLE, KASSANDRA MARIE
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:MARIE
Last Name:VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 W AVENUE L14
Mailing Address - Street 2:
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3506
Mailing Address - Country:US
Mailing Address - Phone:661-649-4417
Mailing Address - Fax:
Practice Address - Street 1:4856 W AVENUE L14
Practice Address - Street 2:
Practice Address - City:QUARTZ HILL
Practice Address - State:CA
Practice Address - Zip Code:93536-3506
Practice Address - Country:US
Practice Address - Phone:661-649-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker