Provider Demographics
NPI:1205067410
Name:DEMONNER, CHERYL S (PA-C)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:S
Last Name:DEMONNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2915
Mailing Address - Fax:
Practice Address - Street 1:1595 SOQUEL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1719
Practice Address - Country:US
Practice Address - Phone:831-475-1111
Practice Address - Fax:831-476-5020
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12663363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical