Provider Demographics
NPI:1932243359
Name:WUNSCH, CHERYL R (MED RNCS)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:WUNSCH
Suffix:
Gender:F
Credentials:MED RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S BARRINGTON AVE
Mailing Address - Street 2:#203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5363
Mailing Address - Country:US
Mailing Address - Phone:323-680-0102
Mailing Address - Fax:818-358-2825
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:#110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:323-680-0102
Practice Address - Fax:818-358-2825
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-265860L101YM0800X
CARN763322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000432303OtherPA BLUE SHIELD
CARN763322OtherRN LICENSE
CARN763322OtherRN LICENSE