Healthcare Provider Details

I. General information

NPI: 1649370446
Provider Name (Legal Business Name): ELNORA CUNNINGHAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

7525 BOYD AVE
CORONA CA
92881-4813
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4723
Mailing address:
  • Phone: 951-270-0434
  • Fax: 951-270-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA11457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: