1336778364 NPI number — CYNTHIA LYNN ROSE ESCAMILLA RN,CPNP

Table of content: CYNTHIA LYNN ROSE ESCAMILLA RN,CPNP (NPI 1336778364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336778364 NPI number — CYNTHIA LYNN ROSE ESCAMILLA RN,CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSE ESCAMILLA
Provider First Name:
CYNTHIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN,CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESCAMILLA
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN,CPNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336778364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15960 JANINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90603-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-947-3519
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15960 JANINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90603-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-947-3519
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0200X , with the licence number:  376659 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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