Provider Demographics
NPI:1295087922
Name:WIRTH, CYNTHIA M (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:WIRTH
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Gender:F
Credentials:RN
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Mailing Address - Street 1:17337 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3903
Mailing Address - Country:US
Mailing Address - Phone:818-981-7845
Mailing Address - Fax:818-457-3787
Practice Address - Street 1:17337 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3903
Practice Address - Country:US
Practice Address - Phone:818-981-7845
Practice Address - Fax:818-457-3787
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA796131363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner