Provider Demographics
NPI:1467016824
Name:CUNANAN, LOURDES (PTA)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:CUNANAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PLATINUM CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-3841
Mailing Address - Country:US
Mailing Address - Phone:415-412-2809
Mailing Address - Fax:
Practice Address - Street 1:1527 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-5448
Practice Address - Country:US
Practice Address - Phone:707-643-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant