Provider Demographics
NPI:1275639247
Name:FAZEKAS, CYNTHIA ANN (RNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:FAZEKAS
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 PACIFIC ST STE B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4400
Mailing Address - Country:US
Mailing Address - Phone:831-648-8000
Mailing Address - Fax:831-648-7799
Practice Address - Street 1:977 PACIFIC ST STE B
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4400
Practice Address - Country:US
Practice Address - Phone:831-648-8000
Practice Address - Fax:831-648-7799
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF5769363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00799099OtherRR MEDICARE
CAP85594Medicare UPIN
CACC357ZMedicare PIN
P00799099OtherRR MEDICARE
CAZZZ27676ZMedicare PIN