Provider Demographics
NPI:1669439832
Name:ADRIANO, CINDY VENIEGAS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:VENIEGAS
Last Name:ADRIANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:PAUMA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92061-0406
Mailing Address - Country:US
Mailing Address - Phone:760-749-1410
Mailing Address - Fax:760-749-1564
Practice Address - Street 1:50100 GOLSH RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-5338
Practice Address - Country:US
Practice Address - Phone:760-749-1410
Practice Address - Fax:760-749-1564
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18005363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11900FMedicaid
CAWPA18005AMedicare ID - Type Unspecified
CAFHC11900FMedicaid