Healthcare Provider Details

I. General information

NPI: 1043443690
Provider Name (Legal Business Name): CYNTHIA A BACA MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BELLEFIELD AVE SUITE 616
PITTSBURGH PA
15213-2600
US

IV. Provider business mailing address

976 PERRY HWY APT 2A
PITTSBURGH PA
15237-2154
US

V. Phone/Fax

Practice location:
  • Phone: 412-246-5259
  • Fax:
Mailing address:
  • Phone: 724-612-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN526462L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: