Provider Demographics
NPI:1619901931
Name:BURKHART, CINDY DIANE (CFM)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:DIANE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2780
Mailing Address - Country:US
Mailing Address - Phone:805-522-1067
Mailing Address - Fax:805-522-9516
Practice Address - Street 1:2824 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2780
Practice Address - Country:US
Practice Address - Phone:805-522-1067
Practice Address - Fax:805-522-9516
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACFM010751744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5168720001Medicare NSC