Healthcare Provider Details

I. General information

NPI: 1346367877
Provider Name (Legal Business Name): CYNTHIA SUE GARDNER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43423 DIVISION ST SUITE 107
LANCASTER CA
93535-4639
US

IV. Provider business mailing address

39609 179TH ST E
PALMDALE CA
93591-3308
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2850
  • Fax: 661-726-2854
Mailing address:
  • Phone: 661-264-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT20499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: