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General NPI Number Information
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NPI Number | 1912789108
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Entity Type | Individual
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Provider Name | CHEREESE MARIE MACKEY
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Gender | Female
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 32387 YUCAIPA BLVD STE A
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City | YUCAIPA
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State | CA
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Zip | 92399-1886
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Country | US
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Telephone | 909-797-9020
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Fax |
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Provider Business Mailing Address
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Address Line | 600 S PLACENTIA AVE STE 600
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City | PLACENTIA
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State | CA
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Zip | 92870-6300
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Country | US
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Telephone | 714-985-9554
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC17839
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License Number State | CA
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