Healthcare Provider Details

I. General information

NPI: 1396948030
Provider Name (Legal Business Name): ANNA E CHEREKOVSKY CMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 9TH ST OASIS
ARCATA CA
95521-5543
US

IV. Provider business mailing address

1798 J ST #A
ARCATA CA
95521-5543
US

V. Phone/Fax

Practice location:
  • Phone: 707-498-1123
  • Fax: 707-442-7774
Mailing address:
  • Phone: 707-498-1123
  • Fax: 707-442-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: