Provider Demographics
NPI:1629252234
Name:CORNELIUS, CYNTHIA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:MARY
Last Name:CORNELIUS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:SAN DIEGO STATE UNIVERSITY STUDENT HEALTH SERVICES
Mailing Address - Street 2:5500 CAMPANILE DRIVE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92182-4701
Mailing Address - Country:US
Mailing Address - Phone:619-594-6681
Mailing Address - Fax:619-594-5613
Practice Address - Street 1:5500 CAMPANILE DR
Practice Address - Street 2:SDSU STUDENT HEALTH SERVICES
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182-0001
Practice Address - Country:US
Practice Address - Phone:619-594-6681
Practice Address - Fax:619-594-5613
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
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Provider Licenses
StateLicense IDTaxonomies
CAG068372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine