Provider Demographics
NPI:1720633944
Name:COATE, CYNTHIA (CINDY)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:COATE
Suffix:
Gender:F
Credentials:CINDY
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:COATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:768 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9260
Mailing Address - Country:US
Mailing Address - Phone:530-621-6322
Mailing Address - Fax:
Practice Address - Street 1:768 PLEASANT VLY RD
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9260
Practice Address - Country:US
Practice Address - Phone:530-621-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40919167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician