Healthcare Provider Details

I. General information

NPI: 1104351121
Provider Name (Legal Business Name): CYNTHIA CUELLAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 PANAMA LN SUITE 102B
BAKERSFIELD CA
93313-3509
US

IV. Provider business mailing address

4900 CALIFORNIA AVE SUITE 400B
BAKERSFIELD CA
93309-7024
US

V. Phone/Fax

Practice location:
  • Phone: 800-300-6664
  • Fax:
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number822343
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: