Healthcare Provider Details

I. General information

NPI: 1710407481
Provider Name (Legal Business Name): CHERIE NICOLE FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N ARROWHEAD AVE STE 300
SAN BERNARDINO CA
92401-1148
US

IV. Provider business mailing address

600 N ARROWHEAD AVE STE 300
SAN BERNARDINO CA
92401-1148
US

V. Phone/Fax

Practice location:
  • Phone: 909-763-5800
  • Fax:
Mailing address:
  • Phone: 909-763-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number85876
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: