Healthcare Provider Details

I. General information

NPI: 1063495356
Provider Name (Legal Business Name): DEBORAH A. CHERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 S HIGUERA ST STE 701
SAN LUIS OBISPO CA
93401-7742
US

IV. Provider business mailing address

4251 S HIGUERA ST STE 701
SAN LUIS OBISPO CA
93401-7742
US

V. Phone/Fax

Practice location:
  • Phone: 805-439-1381
  • Fax: 805-439-0138
Mailing address:
  • Phone: 805-439-1381
  • Fax: 805-439-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG61844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: