Provider Demographics
NPI:1760546873
Name:MATTHEWS-MONDRAGON, CYNTHIA (RN, FNP-BC, MSN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:MATTHEWS-MONDRAGON
Suffix:
Gender:F
Credentials:RN, FNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3629
Mailing Address - Country:US
Mailing Address - Phone:323-908-4200
Mailing Address - Fax:
Practice Address - Street 1:4425 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-3629
Practice Address - Country:US
Practice Address - Phone:323-908-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily