Basic Information
| Provider Information | |||||||||
| NPI: | 1093748006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANATA | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 986 | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952580986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093399036 | ||||||||
| FaxNumber: | 2093391901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1144 NORMAN DR | ||||||||
| Address2: | #104 | ||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953365925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098230827 | ||||||||
| FaxNumber: | 2098235854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 12/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 20A5932 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00AX59320 | 05 | CA | MEDICAID |