Provider Demographics
NPI:1174529416
Name:CAIN, MARK ALAN (RN, NP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:CAIN
Suffix:
Gender:M
Credentials:RN, NP
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 789
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92286-0789
Mailing Address - Country:US
Mailing Address - Phone:760-488-9708
Mailing Address - Fax:
Practice Address - Street 1:6530 LA CONTENTA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7314
Practice Address - Country:US
Practice Address - Phone:760-488-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN263075163WM0102X, 163WN0002X, 163WP0200X, 163WP1700X, 163WW0101X
CANP10894363LF0000X, 363LP0200X, 363LP1700X, 363LW0102X
CA263075163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP10894OtherNURSE PRACTITIONER
CANPF10894OtherNP FURNISHING NUMBER
CARN263075OtherREGISTERED NURSE
CARN263075OtherREGISTERED NURSE
CARN263075OtherREGISTERED NURSE
P14681Medicare UPIN