MEDICARE: MRS. MARGARET JENSEN CHEADLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G63638	CA

General Provider Information

NPI Number	:	1548362155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGARET JENSEN CHEADLE MD

Provider Business Mailing Address
First Line	:	2750 SYCAMORE DR
Second Line	:	STE 202
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1500
Country	:	US
Telephone Number	:	805-527-9140
Fax Number	:	805-527-0783

Provider Business Practice Location Address
First Line	:	2750 SYCAMORE DR
Second Line	:	STE 202
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1500
Country	:	US
Telephone Number	:	805-527-9140
Fax Number	:	805-527-0783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	10/05/2011

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