Healthcare Provider Details

I. General information

NPI: 1528739273
Provider Name (Legal Business Name): CINDY MOUA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7766 N PALM AVE # 107
FRESNO CA
93711-5734
US

IV. Provider business mailing address

7766 N PALM AVE # 107
FRESNO CA
93711-5734
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: