=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023266897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNTHIA A. CORK, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2008
-----------------------------------------------------
Last Update Date | 03/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11180 WARNER AVE SUITE 455
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-556-0536
-----------------------------------------------------
Fax | 714-435-9640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11180 WARNER AVE SUITE 455
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-556-0536
-----------------------------------------------------
Fax | 714-435-9640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CYNTHIA ARLENE CORK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 714-556-0536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | G53015
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------