Most Relevant Information
Provider Data
| NPI Number: | 1003332594 |
| Provider Name: | CYNARA BLACK |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/16/2017 |
| Last Updated: | 08/16/2017 |
Provider Practice Location
9916 CENTRAL AVE.
MONTCLAIR
CA
91763
Practice Location Phone/Fax
| Phone: | 9094502502 |
| Fax: |
Provider Mailing Location
9916 CENTRAL AVE
MONTCLAIR
CA
917633201
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |