Provider Demographics
NPI:1861615783
Name:WHEELER, CHERI DIANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERI
Middle Name:DIANNE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 S WHITE RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2071
Mailing Address - Country:US
Mailing Address - Phone:408-833-5739
Mailing Address - Fax:408-528-8924
Practice Address - Street 1:2670 S WHITE RD
Practice Address - Street 2:SUITE 245
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2071
Practice Address - Country:US
Practice Address - Phone:408-833-5739
Practice Address - Fax:408-528-8939
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY213920Medicaid
CAOPL213920OtherBLUE SHIELD OF CALIFORNIA
CAOPL213920OtherBLUE SHIELD OF CALIFORNIA