Healthcare Provider Details

I. General information

NPI: 1770944704
Provider Name (Legal Business Name): CHERYL FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N ARROWHEAD AVE STE 1B
SAN BERNARDINO CA
92401-1219
US

IV. Provider business mailing address

560 N ARROWHEAD AVE STE 1B
SAN BERNARDINO CA
92401-1219
US

V. Phone/Fax

Practice location:
  • Phone: 800-256-3480
  • Fax:
Mailing address:
  • Phone: 800-256-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number351225
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number351225
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: