Healthcare Provider Details

I. General information

NPI: 1275146037
Provider Name (Legal Business Name): CHERRY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40657 ROAD 128
CUTLER CA
93615-2003
US

IV. Provider business mailing address

40657 ROAD 128
CUTLER CA
93615-2003
US

V. Phone/Fax

Practice location:
  • Phone: 559-234-2112
  • Fax:
Mailing address:
  • Phone: 559-390-0023
  • Fax: 559-426-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERTO RUVALCABA
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 559-390-0023