1750185740 NPI number — CYNTHIA ROSE KIEHN-MOLA MA & PPS CREDENTAIL

Table of content: CYNTHIA ROSE KIEHN-MOLA MA & PPS CREDENTAIL (NPI 1750185740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750185740 NPI number — CYNTHIA ROSE KIEHN-MOLA MA & PPS CREDENTAIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIEHN-MOLA
Provider First Name:
CYNTHIA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA & PPS CREDENTAIL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOLA
Provider Other First Name:
CINDI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA & PPS CREDENTIAL
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750185740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 522
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE LAKE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95525-0522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-825-8804
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1897 S ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-5474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-825-8804
Provider Business Practice Location Address Fax Number:
707-825-1761
Provider Enumeration Date:
04/01/2025

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: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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