Healthcare Provider Details

I. General information

NPI: 1710369046
Provider Name (Legal Business Name): CINAIH MUNGUIA RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15403 PARK AVE E
VICTORVILLE CA
92392-2482
US

IV. Provider business mailing address

15403 PARK AVE E
VICTORVILLE CA
92392-2482
US

V. Phone/Fax

Practice location:
  • Phone: 714-922-4100
  • Fax:
Mailing address:
  • Phone: 714-922-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: