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NPI Code Detail

MEDICARE: MRS. CHERYL LYNN WHITAKER

MEDICARE: MRS. CHERYL LYNN WHITAKER
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1414CA

General Provider Information

NPI Number : 1497931224
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHERYL LYNN WHITAKER
Provider Business Mailing Address
First Line : 7885 ANNANDALE AVE
Second Line :
City : DESERT HOT SPRINGS
State : CA
Zip : 92240-1419
Country : US
Telephone Number : 760-329-2924
Fax Number : 760-329-0169
Provider Business Practice Location Address
First Line : 7885 ANNANDALE AVE
Second Line :
City : DESERT HOT SPRINGS
State : CA
Zip : 92240-1419
Country : US
Telephone Number : 760-329-2924
Fax Number : 760-329-0169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2008
Last Update Date : 01/10/2008

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