Basic Information
Provider Information
NPI: 1306353974
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALFARO
FirstName: CYNTHIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 21458 PEGGY JOYCE LN
Address2:  
City: SANTA CLARITA
State: CA
PostalCode: 913501723
CountryCode: US
TelephoneNumber: 8182316827
FaxNumber:  
Practice Location
Address1: 23502 LYONS AVE STE 304A
Address2:  
City: SANTA CLARITA
State: CA
PostalCode: 913212538
CountryCode: US
TelephoneNumber: 6617020166
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/04/2018
LastUpdateDate: 01/04/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000XRBT-16-18953CAY    

No ID Information.


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