Healthcare Provider Details

I. General information

NPI: 1982724290
Provider Name (Legal Business Name): CYNTHIA A CUPERO R. N. BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W HAPPY VALLEY RD
PEORIA AZ
85383-3278
US

IV. Provider business mailing address

5316 W MOHAWK LN
GLENDALE AZ
85308-9311
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-7610
  • Fax:
Mailing address:
  • Phone: 623-362-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN099668
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: