Provider Demographics
NPI:1548995616
Name:SWALES, CASSANDRA (NP)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SWALES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6535
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93412-6535
Mailing Address - Country:US
Mailing Address - Phone:805-234-0827
Mailing Address - Fax:
Practice Address - Street 1:1320 LAS TABLAS RD STE F
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9711
Practice Address - Country:US
Practice Address - Phone:805-434-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021864363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care