Provider Demographics
NPI:1336121698
Name:CHERRY, EILEEN C (NP)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:C
Last Name:CHERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:C
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN NP
Mailing Address - Street 1:6973 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6339
Mailing Address - Country:US
Mailing Address - Phone:858-279-9676
Mailing Address - Fax:858-179-0377
Practice Address - Street 1:6973 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6339
Practice Address - Country:US
Practice Address - Phone:858-279-9676
Practice Address - Fax:858-179-0377
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN134680363L00000X
CAFNP2737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWMP2737AMedicare ID - Type UnspecifiedPPIN
S50732Medicare UPIN