Healthcare Provider Details

I. General information

NPI: 1427295732
Provider Name (Legal Business Name): CYNTHIA ANN LONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PICACHO ROAD
WINTERHAVEN CA
92283
US

IV. Provider business mailing address

PO BOX 1368
YUMA AZ
85366-1368
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-4100
  • Fax: 760-572-2113
Mailing address:
  • Phone: 760-572-4100
  • Fax: 760-572-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP117337
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: