Provider Demographics
NPI:1790961654
Name:ANDERSON, CYNTHIA LEA (CPNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LEA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LEA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:215 BONAIR ST
Mailing Address - Street 2:APT. 11
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 BONAIR ST
Practice Address - Street 2:APT. 11
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0009
Practice Address - Country:US
Practice Address - Phone:619-532-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17486363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics