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General NPI Number Information
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NPI Number | 1205398138
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Entity Type | Individual
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Provider Name | CYNTHIA WASHBURN
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 238 E 6TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90014-2142
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Country | US
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Telephone | 844-804-0055
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Fax |
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Provider Business Mailing Address
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Address Line | 3439 SE HAWTHORNE BLVD # 419
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City | PORTLAND
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State | OR
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Zip | 97214-5048
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Country | US
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Telephone | 510-599-4966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 58875
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License Number State | CA
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