Provider Demographics
NPI:1225592645
Name:EHIEMERE, CHINE
Entity Type:Individual
Prefix:
First Name:CHINE
Middle Name:
Last Name:EHIEMERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41760 IVY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9408
Mailing Address - Country:US
Mailing Address - Phone:951-200-5532
Mailing Address - Fax:
Practice Address - Street 1:41760 IVY ST STE 202
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9408
Practice Address - Country:US
Practice Address - Phone:951-200-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician