Healthcare Provider Details

I. General information

NPI: 1316524952
Provider Name (Legal Business Name): CYNTHIA YVETTE NINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ATLANTIC AVE
LONG BEACH CA
90806-5502
US

IV. Provider business mailing address

1900 ATLANTIC AVE
LONG BEACH CA
90806-5502
US

V. Phone/Fax

Practice location:
  • Phone: 562-277-9405
  • Fax: 562-283-1501
Mailing address:
  • Phone: 562-277-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA203820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: