Healthcare Provider Details

I. General information

NPI: 1790190064
Provider Name (Legal Business Name): CHERRELLE L NGUYEN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERRELLE L JONES DPM

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E CENTER AVE
VISALIA CA
93291-6331
US

IV. Provider business mailing address

305 E CENTER AVE
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 877-960-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006623
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: