Healthcare Provider Details

I. General information

NPI: 1780512640
Provider Name (Legal Business Name): GEMA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 MAPLE ST
AUBURN CA
95603-5041
US

IV. Provider business mailing address

5132 ROSBURY DELL PL
ANTELOPE CA
95843-5937
US

V. Phone/Fax

Practice location:
  • Phone: 916-370-7356
  • Fax:
Mailing address:
  • Phone: 916-370-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: