Provider Demographics
NPI:1003871450
Name:JAMES, CYNTHIA GAYLE (PA)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:GAYLE
Last Name:JAMES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:STE 703
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4807
Mailing Address - Country:US
Mailing Address - Phone:213-977-7422
Mailing Address - Fax:213-250-8945
Practice Address - Street 1:41210 11TH ST W
Practice Address - Street 2:STE G
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1447
Practice Address - Country:US
Practice Address - Phone:661-538-2222
Practice Address - Fax:661-538-2224
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14068363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14068Medicaid
S97623Medicare UPIN
CAPA14068Medicaid