Provider Demographics
NPI:1952700320
Name:CARRASCO-GONZALEZ, CYNTHIA CRYSTAL (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CRYSTAL
Last Name:CARRASCO-GONZALEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:CRYSTAL
Other - Last Name:CARRASCO-GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2163 ASSOCIATED RD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1355
Mailing Address - Country:US
Mailing Address - Phone:562-260-5699
Mailing Address - Fax:
Practice Address - Street 1:100 E VALENCIA MESA DR
Practice Address - Street 2:SUITE 111
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3813
Practice Address - Country:US
Practice Address - Phone:714-446-5677
Practice Address - Fax:714-446-5619
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013719363LF0000X
CA788748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily