Healthcare Provider Details

I. General information

NPI: 1073132080
Provider Name (Legal Business Name): CINDY CERDA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 LONG BEACH BLVD
LONG BEACH CA
90807-3340
US

IV. Provider business mailing address

3745 LONG BEACH BLVD STE 100
LONG BEACH CA
90807-3340
US

V. Phone/Fax

Practice location:
  • Phone: 310-787-9334
  • Fax:
Mailing address:
  • Phone: 310-787-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: