Healthcare Provider Details

I. General information

NPI: 1801072301
Provider Name (Legal Business Name): CYNTHIA KINGERY R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3179 ALTA LAGUNA BLVD
LAGUNA BEACH CA
92651-2061
US

IV. Provider business mailing address

1180 OLYMPIC DR SUITE 108
CORONA CA
92881-3393
US

V. Phone/Fax

Practice location:
  • Phone: 949-464-9263
  • Fax: 951-272-2815
Mailing address:
  • Phone: 951-278-5590
  • Fax: 951-272-2815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License NumberRHM41857
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License NumberRHM41857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: