Provider Demographics
NPI:1326638354
Name:CUNNINGHAM, SENTA ANNE (PPS)
Entity Type:Individual
Prefix:
First Name:SENTA
Middle Name:ANNE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:MRS
Other - First Name:SENTA
Other - Middle Name:ANNE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1172 MARGUERITE AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-2959
Mailing Address - Country:US
Mailing Address - Phone:209-647-9399
Mailing Address - Fax:
Practice Address - Street 1:1172 MARGUERITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-2959
Practice Address - Country:US
Practice Address - Phone:209-647-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool