Healthcare Provider Details

I. General information

NPI: 1124691977
Provider Name (Legal Business Name): ASHLEY KEISHA CYPRIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20342 FLANAGAN ROAD
TRABUCO CANYON CA
92679
US

IV. Provider business mailing address

713 N SPURGEON ST APT 1
SANTA ANA CA
92701-3774
US

V. Phone/Fax

Practice location:
  • Phone: 818-582-8832
  • Fax: 818-582-8836
Mailing address:
  • Phone: 818-569-9598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: