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General NPI Number Information
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NPI Number | 1104704899
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Entity Type | Individual
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Provider Name | CHERYL LATARSHA STURDIVANT
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Gender | Female
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 2633 E 27TH ST
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City | OAKLAND
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State | CA
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Zip | 94601-1912
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Country | US
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Telephone | 510-536-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 821 NAPA ST
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City | VALLEJO
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State | CA
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Zip | 94590-6129
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Country | US
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Telephone | 707-880-4242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | 33106
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License Number State | CA
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