Healthcare Provider Details

I. General information

NPI: 1295707743
Provider Name (Legal Business Name): VICENTA CUNTAPAY ANQUE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 K ST
BRAWLEY CA
92227-2737
US

IV. Provider business mailing address

223 W COLE BLVD
CALEXICO CA
92231-9722
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-9951
  • Fax: 760-344-1629
Mailing address:
  • Phone: 760-357-2020
  • Fax: 760-357-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number345872
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number12183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: