Provider Demographics
NPI:1467643460
Name:BOBRIK, CHERYL DIANE
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DIANE
Last Name:BOBRIK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:DIANE
Other - Last Name:TALBOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19012 N 25TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-2573
Mailing Address - Country:US
Mailing Address - Phone:602-569-5117
Mailing Address - Fax:
Practice Address - Street 1:19012 N 25TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-2573
Practice Address - Country:US
Practice Address - Phone:602-569-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ240829171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor