Basic Information
| Provider Information | |||||||||
| NPI: | 1639420516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CYGANIK | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | JOYCE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.C/MFC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2122 S EL CAMINO REAL | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920546208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604732229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2865 LOGAN AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921132411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192324357 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 97854 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.