Provider Demographics
NPI:1558869719
Name:PAQUIN, CINDY MARLENE (RPT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:MARLENE
Last Name:PAQUIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17709 CORTNER AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8119
Mailing Address - Country:US
Mailing Address - Phone:562-618-9283
Mailing Address - Fax:
Practice Address - Street 1:17709 CORTNER AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8119
Practice Address - Country:US
Practice Address - Phone:562-618-9283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT12115OtherSTATE OF CA