Provider Demographics
NPI:1699260505
Name:CIFUENTES, NICOLE AURORA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:AURORA
Last Name:CIFUENTES
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 1:3043 89TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1416
Mailing Address - Country:US
Mailing Address - Phone:646-683-2723
Mailing Address - Fax:
Practice Address - Street 1:16216 UNION TPKE STE 303
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1960
Practice Address - Country:US
Practice Address - Phone:718-264-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator