Provider Demographics
NPI:1235897125
Name:PELLEGRIN, CYNTHIA SHAKIRA
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SHAKIRA
Last Name:PELLEGRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9665 BOXWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5926
Mailing Address - Country:US
Mailing Address - Phone:951-258-2605
Mailing Address - Fax:
Practice Address - Street 1:9665 BOXWOOD AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5926
Practice Address - Country:US
Practice Address - Phone:951-258-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician