Basic Information
| Provider Information | |||||||||
| NPI: | 1669439832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADRIANO | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | VENIEGAS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 406 | ||||||||
| Address2: | |||||||||
| City: | PAUMA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920610406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607491410 | ||||||||
| FaxNumber: | 7607491564 | ||||||||
| Practice Location | |||||||||
| Address1: | 50100 GOLSH RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CENTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920825338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607491410 | ||||||||
| FaxNumber: | 7607491564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 03/23/2010 | ||||||||
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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 | 363AM0700X | PA18005 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | FHC11900F | 05 | CA | MEDICAID |