Provider Demographics
NPI:1891036067
Name:CINCIS, CRAIG AARON
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:AARON
Last Name:CINCIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40349 REATA RD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2167
Mailing Address - Country:US
Mailing Address - Phone:661-435-1359
Mailing Address - Fax:
Practice Address - Street 1:190 SIERRA CT
Practice Address - Street 2:BLDG B11, SUITE 112
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4089
Practice Address - Country:US
Practice Address - Phone:661-544-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112154106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL