Provider Demographics
NPI:1619986882
Name:CUNNEEN, MICHELE BERNADETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:BERNADETTE
Last Name:CUNNEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 LOMA VISTA RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3081
Mailing Address - Country:US
Mailing Address - Phone:805-642-8107
Mailing Address - Fax:805-642-0964
Practice Address - Street 1:3442 LOMA VISTA RD
Practice Address - Street 2:SUITE C
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3081
Practice Address - Country:US
Practice Address - Phone:805-642-8107
Practice Address - Fax:805-642-0964
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BC3433694OtherD.E.A.
CAF78459Medicare UPIN
CAG75319Medicare ID - Type Unspecified