Provider Demographics
NPI:1740831429
Name:CARBAJAL, CYNTHIA MICHELLE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MICHELLE
Last Name:CARBAJAL
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 1:1324 ALBRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4322
Mailing Address - Country:US
Mailing Address - Phone:442-200-7676
Mailing Address - Fax:
Practice Address - Street 1:768 GRANT ST
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-3436
Practice Address - Country:US
Practice Address - Phone:760-693-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD4007954OtherDRIVER LICENSE