Provider Demographics
NPI:1609168590
Name:ROLLINS-ALLEN, CHERYL
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:ROLLINS-ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 RIVERSIDE DR
Mailing Address - Street 2:MAA/LEA/EPSDT PROGRAMS
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4130
Mailing Address - Country:US
Mailing Address - Phone:909-628-1201
Mailing Address - Fax:909-548-6046
Practice Address - Street 1:12970 3RD ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3464
Practice Address - Country:US
Practice Address - Phone:909-628-1201
Practice Address - Fax:909-548-6046
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist