Healthcare Provider Details

I. General information

NPI: 1285491126
Provider Name (Legal Business Name): CYNTHIA MARIA PATINO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25791 DREW CIR
HOMELAND CA
92548-9156
US

IV. Provider business mailing address

25791 DREW CIR
HOMELAND CA
92548-9156
US

V. Phone/Fax

Practice location:
  • Phone: 951-467-0362
  • Fax:
Mailing address:
  • Phone: 951-467-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: