Provider Demographics
NPI:1538518220
Name:CHEONG, NICOLE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CHEONG
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W BLAINE ST
Mailing Address - Street 2:APT 9
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7611
Mailing Address - Country:US
Mailing Address - Phone:650-303-5192
Mailing Address - Fax:
Practice Address - Street 1:1200 W BLAINE ST
Practice Address - Street 2:APT 9
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7611
Practice Address - Country:US
Practice Address - Phone:650-303-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer