Healthcare Provider Details

I. General information

NPI: 1508968181
Provider Name (Legal Business Name): CYNTHIA E HOARD EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W ROSE LN
PHOENIX AZ
85015-2043
US

IV. Provider business mailing address

1818 W ROSE LN
PHOENIX AZ
85015-2043
US

V. Phone/Fax

Practice location:
  • Phone: 602-616-9682
  • Fax: 602-336-9682
Mailing address:
  • Phone: 602-616-9682
  • Fax: 602-336-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2064
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: