Provider Demographics
NPI:1659413318
Name:MCCORMACK, CINDI D (PAC)
Entity Type:Individual
Prefix:
First Name:CINDI
Middle Name:D
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2903
Mailing Address - Country:US
Mailing Address - Phone:831-424-3300
Mailing Address - Fax:
Practice Address - Street 1:45 E SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2903
Practice Address - Country:US
Practice Address - Phone:831-424-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003893363AM0700X
CAPA22281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01962Medicare UPIN
HC308ZMedicare PIN