Provider Demographics
NPI:1104447812
Name:CUNNINGHAM, CAMBRIA
Entity type:Individual
Prefix:
First Name:CAMBRIA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6813
Mailing Address - Country:US
Mailing Address - Phone:559-299-2608
Mailing Address - Fax:
Practice Address - Street 1:29323 AUBERRY RD
Practice Address - Street 2:
Practice Address - City:PRATHER
Practice Address - State:CA
Practice Address - Zip Code:93651-9757
Practice Address - Country:US
Practice Address - Phone:559-855-5390
Practice Address - Fax:855-338-3835
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106640122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program