Provider Demographics
NPI:1770124927
Name:CUNNINGHAM, ISIS YUDIT (DNP)
Entity type:Individual
Prefix:DR
First Name:ISIS
Middle Name:YUDIT
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 CAMINO CALABAZO
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-8113
Mailing Address - Country:US
Mailing Address - Phone:619-339-0311
Mailing Address - Fax:
Practice Address - Street 1:333 H ST STE 2000
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5556
Practice Address - Country:US
Practice Address - Phone:619-427-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95012087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner