Provider Demographics
NPI:1265503981
Name:PENNE MYERS, CHERRI LOUISE (PAC)
Entity Type:Individual
Prefix:MS
First Name:CHERRI
Middle Name:LOUISE
Last Name:PENNE MYERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 BRISTOL STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:949-266-3700
Mailing Address - Fax:949-266-3750
Practice Address - Street 1:3150 BRISTOL STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:949-266-3700
Practice Address - Fax:949-266-3750
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16919363LP0808X
CAMP1072557363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health