Healthcare Provider Details

I. General information

NPI: 1104447812
Provider Name (Legal Business Name): CAMBRIA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29323 AUBERRY RD
PRATHER CA
93651-9757
US

IV. Provider business mailing address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-855-5390
  • Fax: 855-338-3835
Mailing address:
  • Phone: 559-299-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number106640
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: