Provider Demographics
NPI: | 1659571024 |
---|---|
Name: | SEELEY, CHERIDAH JONES (PAC) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | CHERIDAH |
Middle Name: | JONES |
Last Name: | SEELEY |
Suffix: | |
Gender: | F |
Credentials: | PAC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 38900 TRADE CENTER DR STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | PALMDALE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93551-3715 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 661-839-0574 |
Mailing Address - Fax: | 661-839-0963 |
Practice Address - Street 1: | 44215 15TH ST W STE 315 |
Practice Address - Street 2: | |
Practice Address - City: | LANCASTER |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93534-5505 |
Practice Address - Country: | US |
Practice Address - Phone: | 661-945-4581 |
Practice Address - Fax: | 661-949-5887 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-07-23 |
Last Update Date: | 2021-12-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PA13993 | 363A00000X, 363AM0700X, 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |