Healthcare Provider Details

I. General information

NPI: 1952900524
Provider Name (Legal Business Name): CHEYENNE PIMENTEL PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 N DUTTON AVE # 95401
SANTA ROSA CA
95401-4609
US

IV. Provider business mailing address

1800 HWY 116 N
SEBASTOPOL CA
95472-2607
US

V. Phone/Fax

Practice location:
  • Phone: 707-888-2927
  • Fax:
Mailing address:
  • Phone: 707-494-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: