Provider Demographics
NPI:1285494153
Name:CANCINO, CHEYANNE ELENA (LAC)
Entity type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:ELENA
Last Name:CANCINO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3508
Mailing Address - Country:US
Mailing Address - Phone:619-203-2528
Mailing Address - Fax:
Practice Address - Street 1:535 16TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3508
Practice Address - Country:US
Practice Address - Phone:619-203-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20025171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist