Basic Information
| Provider Information | |||||||||
| NPI: | 1720039936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANSINO | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4860 Y STREET, SUITE 2500 | ||||||||
| Address2: | DEPARTMENT OF OBSTETRICS AND GYNECOLOGY | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346900 | ||||||||
| FaxNumber: | 9167342158 | ||||||||
| Practice Location | |||||||||
| Address1: | 4860 Y STREET, SUITE 2500 | ||||||||
| Address2: | DEPARTMENT OF OBSTETRICS AND GYNECOLOGY | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346900 | ||||||||
| FaxNumber: | 9167342158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 11/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D64402 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD20080671 | NM | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D0064402 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 35095223 | OH | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | C55562 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3044459 | 05 | OH | MEDICAID |