Provider Demographics
NPI:1710776901
Name:GONZALEZ, CASSANDRA ESTRELLA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ESTRELLA
Last Name:GONZALEZ
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 1:3308 W 113TH ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2202
Mailing Address - Country:US
Mailing Address - Phone:310-985-4157
Mailing Address - Fax:
Practice Address - Street 1:3308 W 113TH ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2202
Practice Address - Country:US
Practice Address - Phone:310-985-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHRPSS009273175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist