Provider Demographics
NPI:1962197731
Name:CUNANAN, EDWIN ALDRIN (NP)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:ALDRIN
Last Name:CUNANAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7834 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-8831
Mailing Address - Country:US
Mailing Address - Phone:626-898-3807
Mailing Address - Fax:
Practice Address - Street 1:191 E ALESSANDRO BLVD STE 9A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5095
Practice Address - Country:US
Practice Address - Phone:951-780-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily