Provider Demographics
NPI:1013441351
Name:SIMMONS, CYNTHIA (VN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:VN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13337 LINGRE AVE
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-3338
Mailing Address - Country:US
Mailing Address - Phone:760-703-1859
Mailing Address - Fax:
Practice Address - Street 1:13337 LINGRE AVE
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-3338
Practice Address - Country:US
Practice Address - Phone:760-703-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273821164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse