Provider Demographics
NPI:1164686580
Name:ROSETE, CHERYL M (PHD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:ROSETE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:M
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:623 E LATHAM AVE OFC
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4342
Mailing Address - Country:US
Mailing Address - Phone:951-581-0224
Mailing Address - Fax:
Practice Address - Street 1:3102 E. HIGHLAND AVENUE
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:PATTON
Practice Address - State:CA
Practice Address - Zip Code:92369
Practice Address - Country:US
Practice Address - Phone:909-425-7679
Practice Address - Fax:909-425-6635
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 225400000X
CAPSY25116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner