Provider Demographics
NPI:1518003250
Name:PFENT, CHERYL ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:PFENT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24813 ICELAND POPPY CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563
Mailing Address - Country:US
Mailing Address - Phone:951-600-7859
Mailing Address - Fax:
Practice Address - Street 1:790 VIA LATA
Practice Address - Street 2:SUITE 250
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3978
Practice Address - Country:US
Practice Address - Phone:909-872-0223
Practice Address - Fax:909-872-1686
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18285103TC0700X
FLPY4330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical