Provider Demographics
NPI:1578713053
Name:TANITA, CHERYL S (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:TANITA
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 OLD NEWPORT BOULEVARD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-631-4327
Mailing Address - Fax:949-631-2030
Practice Address - Street 1:446 OLD NEWPORT BLVD STE 100
Practice Address - Street 2:UNITED STATES
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4246
Practice Address - Country:US
Practice Address - Phone:949-631-4327
Practice Address - Fax:949-631-2030
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2313231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist