Individual
CINDY ILLESCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
101 THE CITY DR S, ORANGE, CA 92868-3201
(714) 880-7812
Mailing address
200 S MANCHESTER AVE STE 300, ORANGE, CA 92868-3219
(714) 456-2986
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95002098
CA
363LF0000X
Family Nurse Practitioner
95002098
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2018015179
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
826189
RN
CA
01
—
95002098
FURNISHING NUMBER
CA
Enumeration date
03/09/2016
Last updated
01/24/2024
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