Provider Demographics
NPI:1215151220
Name:FENBERG, CYNTHIA A (DPM)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:FENBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 CIRQUE DR W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3604
Mailing Address - Country:US
Mailing Address - Phone:253-474-4353
Mailing Address - Fax:253-474-5850
Practice Address - Street 1:5225 CIRQUE DR W
Practice Address - Street 2:SUITE 100
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3604
Practice Address - Country:US
Practice Address - Phone:253-474-4353
Practice Address - Fax:253-474-5850
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1704105Medicaid
WA18889OtherL & I
WA1704105Medicaid
T02697Medicare UPIN