Provider Demographics
NPI:1780135830
Name:MARTIN-MICHALEC, CYNTHIA JUNE (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JUNE
Last Name:MARTIN-MICHALEC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:JUNE
Other - Last Name:FANDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1904 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-4562
Mailing Address - Country:US
Mailing Address - Phone:209-341-1824
Mailing Address - Fax:
Practice Address - Street 1:1817 THOMAS TAYLOR DR
Practice Address - Street 2:
Practice Address - City:HUGHSON
Practice Address - State:CA
Practice Address - Zip Code:95326-8911
Practice Address - Country:US
Practice Address - Phone:209-485-8821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353930163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health