Healthcare Provider Details

I. General information

NPI: 1174529416
Provider Name (Legal Business Name): MARK ALAN CAIN R.N., N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 LA CONTENTA RD SUITE 300
YUCCA VALLEY CA
92284-7314
US

IV. Provider business mailing address

PO BOX 789
YUCCA VALLEY CA
92286-0789
US

V. Phone/Fax

Practice location:
  • Phone: 760-488-9708
  • Fax:
Mailing address:
  • Phone: 760-488-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN263075
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN263075
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN263075
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberRN263075
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN263075
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP10894
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP10894
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License NumberNP10894
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP10894
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number263075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: