Provider Demographics
NPI:1972048601
Name:ZAVALA, CYNTHIA MARIA (CPNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIA
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5681 CRESTLINE PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2134
Mailing Address - Country:US
Mailing Address - Phone:626-347-7141
Mailing Address - Fax:
Practice Address - Street 1:1970 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5202
Practice Address - Country:US
Practice Address - Phone:951-213-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95005543363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics