MEDICARE: MRS. CYNTHIA E CHEN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	9631	CA

General Provider Information

NPI Number	:	1437205770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA E CHEN FNP

Provider Business Mailing Address
First Line	:	280 CAGNEY LN
Second Line	:	APT 307
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-1620
Country	:	US
Telephone Number	:	949-500-9354
Fax Number	:	949-645-5747

Provider Business Practice Location Address
First Line	:	2077 HARBOR BLVD
Second Line	:	SUITE C
City	:	COSTA MESA
State	:	CA
Zip	:	92627
Country	:	US
Telephone Number	:	949-722-2510
Fax Number	:	949-722-2511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	04/03/2018

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