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NPI Code Detail

MEDICARE: CHERYL LYNN ELDRIDGE PA-C

MEDICARE: CHERYL LYNN ELDRIDGE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA15080CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA15080OTHERCAPA LICENSE NUMBER

General Provider Information

NPI Number : 1336246438
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL LYNN ELDRIDGE PA-C
Provider Business Mailing Address
First Line : 1450 TREAT BLVD # 300
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94597-2168
Country : US
Telephone Number : 925-952-2828
Fax Number : 510-452-1102
Provider Business Practice Location Address
First Line : 365 HAWTHORNE AVE STE 201
Second Line :
City : OAKLAND
State : CA
Zip : 94609-3114
Country : US
Telephone Number : 510-452-1345
Fax Number : 510-452-1102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 01/17/2023

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