Provider Demographics
NPI:1699800896
Name:ROUSSOS, CHERIE JOANNE (RD, CDE)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:JOANNE
Last Name:ROUSSOS
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:JOANNE
Other - Last Name:ENGLERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:2929 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2762
Mailing Address - Country:US
Mailing Address - Phone:858-939-6625
Mailing Address - Fax:858-874-3016
Practice Address - Street 1:2929 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2762
Practice Address - Country:US
Practice Address - Phone:858-939-6625
Practice Address - Fax:858-874-3016
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726680133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM876ZMedicare Oscar/Certification