Basic Information
| Provider Information | |||||||||
| NPI: | 1851974810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE-LASSITER | ||||||||
| FirstName: | CACLINH | ||||||||
| MiddleName: | THAI | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11455 WOOLINGTON RD | ||||||||
| Address2: | |||||||||
| City: | GREAT FALLS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220661162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039966311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3050 S UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542627500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2021 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.