1457771107 NPI number — CHERISSE ANTOINETTE BENT MWERO M.D.

Table of content: CHERISSE ANTOINETTE BENT MWERO M.D. (NPI 1457771107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457771107 NPI number — CHERISSE ANTOINETTE BENT MWERO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MWERO
Provider First Name:
CHERISSE
Provider Middle Name:
ANTOINETTE BENT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENT
Provider Other First Name:
CHERISSE
Provider Other Middle Name:
ANTOINETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457771107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4860 Y ST
Provider Second Line Business Mailing Address:
SUITE 3600
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-2307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-3514
Provider Business Mailing Address Fax Number:
916-734-6525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10956 DONNER PASS RD STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUCKEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96161-4863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-582-6368
Provider Business Practice Location Address Fax Number:
530-550-6749
Provider Enumeration Date:
04/21/2014

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: 2084N0400X , with the licence number:  A140158 , 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)