Healthcare Provider Details

I. General information

NPI: 1659571024
Provider Name (Legal Business Name): CHERIDAH JONES LIGNIER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42357 50TH ST W STE 107
QUARTZ HILL CA
93536-3529
US

IV. Provider business mailing address

42357 50TH ST W STE 107
QUARTZ HILL CA
93536-3529
US

V. Phone/Fax

Practice location:
  • Phone: 661-943-6455
  • Fax: 661-718-1580
Mailing address:
  • Phone: 661-943-6455
  • Fax: 661-718-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA13993
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13993
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA13993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: