Provider Demographics
NPI:1467601542
Name:CUNNINGHAM, CYNTHIA MARIE (LPT/LVN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LPT/LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3910
Mailing Address - Country:US
Mailing Address - Phone:714-895-1985
Mailing Address - Fax:714-898-5269
Practice Address - Street 1:206 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3910
Practice Address - Country:US
Practice Address - Phone:714-895-1985
Practice Address - Fax:714-898-5269
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN119750164X00000X
CAPT20573167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No164X00000XNursing Service ProvidersLicensed Vocational Nurse