1932243359 NPI number — CHERYL R WUNSCH MED RNCS

Table of content: CHERYL R WUNSCH MED RNCS (NPI 1932243359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932243359 NPI number — CHERYL R WUNSCH MED RNCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WUNSCH
Provider First Name:
CHERYL
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED RNCS
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:
1932243359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 S BARRINGTON AVE
Provider Second Line Business Mailing Address:
#203
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-5363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-680-0102
Provider Business Mailing Address Fax Number:
818-358-2825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 S BARRINGTON AVE
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-5363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-680-0102
Provider Business Practice Location Address Fax Number:
818-358-2825
Provider Enumeration Date:
02/18/2007

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: 101YM0800X , with the licence number:  RN-265860L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: RN763322 , 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)

  • Identifier: 0000432303 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RN763322 . This is a "RN LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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