Provider Demographics
NPI:1093748006
Name:VANATA, CYNTHIA M (DO)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:VANATA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-0986
Mailing Address - Country:US
Mailing Address - Phone:209-339-9036
Mailing Address - Fax:209-339-1901
Practice Address - Street 1:1144 NORMAN DR
Practice Address - Street 2:#104
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5925
Practice Address - Country:US
Practice Address - Phone:209-823-0827
Practice Address - Fax:209-823-5854
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5932207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX59320Medicaid
CA00AX59320Medicaid
F21859Medicare UPIN