Individual
DR. DAVID LEE CASSIDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18944 MOUNT CIMARRON ST, FOUNTAIN VALLEY, CA 92708-7313
(714) 968-7706
Mailing address
18944 MOUNT CIMARRON ST, FOUNTAIN VALLEY, CA 92708-7313
(714) 968-7706
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
C28354
CA
2085N0904X
Nuclear Radiology Physician
C28354
CA
2085R0202X
Diagnostic Radiology Physician
Primary
C28354
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C283540
BLUE SHIELD
CA
05
—
00C283540
—
CA
01
—
00C283540221
CALOPTIMA
CA
Enumeration date
05/04/2006
Last updated
11/27/2007
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