Provider Demographics
NPI:1134956816
Name:FELICIANO, CASSANDRA KARI
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:KARI
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:KARI
Other - Last Name:VELUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11251 ROSARITA DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3209
Mailing Address - Country:US
Mailing Address - Phone:909-583-1472
Mailing Address - Fax:
Practice Address - Street 1:29826 HAUN RD STE 314
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6546
Practice Address - Country:US
Practice Address - Phone:951-381-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65329363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA65329OtherPHYSICIAN ASSISTANT BOARD OF CALIFORNIA