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General NPI Number Information
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NPI Number | 1508392762
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Entity Type | Individual
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Provider Name | CHEYENNE ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 2295 S. VINEYARD AVE MOD 'B' STE. 230
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City | ONTARIO
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State | CA
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Zip | 91761
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Country | US
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Telephone | 909-724-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 2295 S. VINEYARD AVE MOB 'D' STE 230
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City | ONTARIO
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State | CA
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Zip | 91761
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Country | US
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Telephone | 909-587-7214
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW66720
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License Number State | CA
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