Provider Demographics
NPI:1790533669
Name:CLAIBORNE, CASSANDRA GAYE (NURSE)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:GAYE
Last Name:CLAIBORNE
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 E CENTURY BLVD APT 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-4019
Mailing Address - Country:US
Mailing Address - Phone:318-485-4521
Mailing Address - Fax:
Practice Address - Street 1:2185 E CENTURY BLVD APT 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-4019
Practice Address - Country:US
Practice Address - Phone:318-482-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No172A00000XOther Service ProvidersDriver