Healthcare Provider Details

I. General information

NPI: 1932243359
Provider Name (Legal Business Name): CHERYL R WUNSCH MED RNCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE #110
LOS ANGELES CA
90025-5363
US

IV. Provider business mailing address

2001 S BARRINGTON AVE #203
LOS ANGELES CA
90025-5363
US

V. Phone/Fax

Practice location:
  • Phone: 323-680-0102
  • Fax: 818-358-2825
Mailing address:
  • Phone: 323-680-0102
  • Fax: 818-358-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRN-265860L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRN763322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: