Provider Demographics
NPI:1144320987
Name:POWELL, CHERYL JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:JEAN
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:231 W VERNON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2778
Mailing Address - Country:US
Mailing Address - Phone:323-233-6271
Mailing Address - Fax:323-233-8196
Practice Address - Street 1:231 W VERNON AVE STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2778
Practice Address - Country:US
Practice Address - Phone:323-233-6271
Practice Address - Fax:323-233-8196
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2025-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG58108207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G581081Medicaid
CAE02830Medicare UPIN
CA00G581081Medicaid