Provider Demographics
NPI:1245508118
Name:FAN, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E YALE LOOP
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7551
Mailing Address - Country:US
Mailing Address - Phone:949-336-7231
Mailing Address - Fax:
Practice Address - Street 1:1538 E WARNER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5476
Practice Address - Country:US
Practice Address - Phone:714-434-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA895225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist