1396978508 NPI number — MISS CHERIE KNOPF ADMINISTRATOR

Table of content: MISS CHERIE KNOPF ADMINISTRATOR (NPI 1396978508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396978508 NPI number — MISS CHERIE KNOPF ADMINISTRATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOPF
Provider First Name:
CHERIE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ADMINISTRATOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396978508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26115 SALLY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE FOREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92630-5540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-916-4304
Provider Business Practice Location Address Fax Number:
949-916-4304
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  300187AP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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