Healthcare Provider Details

I. General information

NPI: 1164686580
Provider Name (Legal Business Name): CHERYL M ROSETE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERYL M JACOBS PH.D.

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 E. HIGHLAND AVENUE MEDICAL STAFF OFFICE
PATTON CA
92369
US

IV. Provider business mailing address

623 E LATHAM AVE OFC
HEMET CA
92543-4342
US

V. Phone/Fax

Practice location:
  • Phone: 909-425-7679
  • Fax: 909-425-6635
Mailing address:
  • Phone: 951-581-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: