Provider Demographics
NPI:1871960708
Name:WONG, CASSANDRA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12746 W JEFFERSON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2885
Mailing Address - Country:US
Mailing Address - Phone:424-315-2240
Mailing Address - Fax:
Practice Address - Street 1:12746 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094
Practice Address - Country:US
Practice Address - Phone:310-248-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764866363LF0000X
CA95000426363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily