Healthcare Provider Details

I. General information

NPI: 1093845216
Provider Name (Legal Business Name): MRS. CYNTHIA LANORA CUMMINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 EL NIDO DR
ALTADENA CA
91001-4599
US

IV. Provider business mailing address

2933 EL NIDO DR
ALTADENA CA
91001-4599
US

V. Phone/Fax

Practice location:
  • Phone: 626-531-5941
  • Fax: 626-795-4531
Mailing address:
  • Phone: 626-395-7100
  • Fax: 626-798-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: