Provider Demographics
NPI:1225759665
Name:CINEUS, MYRIAM (DDS)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:CINEUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25039 STARR ST APT 5
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2831
Mailing Address - Country:US
Mailing Address - Phone:754-281-1266
Mailing Address - Fax:
Practice Address - Street 1:1115 S SANDERSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-9047
Practice Address - Country:US
Practice Address - Phone:951-404-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1079671223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice