Provider Demographics
NPI:1508147414
Name:JANNSON, CYNTHIA L (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:JANNSON
Suffix:
Gender:F
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11566 RACETRACK RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8037
Mailing Address - Country:US
Mailing Address - Phone:209-532-2700
Mailing Address - Fax:
Practice Address - Street 1:11566 RACETRACK RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8037
Practice Address - Country:US
Practice Address - Phone:209-532-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist