Provider Demographics
NPI: | 1649819368 |
---|---|
Name: | SEPULVEDA, CYNTHIA NEAL (FNP-C) |
Entity type: | Individual |
Prefix: | |
First Name: | CYNTHIA |
Middle Name: | NEAL |
Last Name: | SEPULVEDA |
Suffix: | |
Gender: | F |
Credentials: | FNP-C |
Other - Prefix: | |
Other - First Name: | CYNTHIA |
Other - Middle Name: | NEAL |
Other - Last Name: | STEIGER |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 5630 E SANTA ANA CANYON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ANAHEIM |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92807-3122 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-257-6172 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5630 E SANTA ANA CANYON RD |
Practice Address - Street 2: | |
Practice Address - City: | ANAHEIM |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92807-3122 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-257-6172 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-12-27 |
Last Update Date: | 2024-10-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 95011988 | 363L00000X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NONE | Other | NONE |