MEDICARE: MISS CHERIE KNOPF ADMINISTRATOR

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	300187AP	CA

General Provider Information

NPI Number	:	1396978508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHERIE KNOPF ADMINISTRATOR

Provider Business Mailing Address
First Line	:	24310 MOULTON PKWY
Second Line	:	SUITE O-618
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-3306
Country	:	US
Telephone Number	:	949-636-5268
Fax Number	:	949-916-4304

Provider Business Practice Location Address
First Line	:	26115 SALLY DR
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-5540
Country	:	US
Telephone Number	:	949-916-4304
Fax Number	:	949-916-4304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/08/2009

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