Provider Demographics
NPI:1073569026
Name:DURSTEIN-DECKER, CHERYL (MD FACEP)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:DURSTEIN-DECKER
Suffix:
Gender:F
Credentials:MD FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6917
Mailing Address - Country:US
Mailing Address - Phone:805-346-3456
Mailing Address - Fax:805-346-3454
Practice Address - Street 1:1325 E CHURCH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5909
Practice Address - Country:US
Practice Address - Phone:805-346-3456
Practice Address - Fax:805-346-3454
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78446174400000X
CAC55590207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47083VMedicare PIN
H00439Medicare UPIN