Individual
DR. CHERYL L KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
30131 TOWN CENTER DR, SUITE 204, LAGUNA NIGUEL, CA 92677-2034
(949) 342-1780
(949) 342-1786
Mailing address
30100 TOWN CENTER DR, SUITE O #437, LAGUNA NIGUEL, CA 92677-2064
(949) 342-1780
(949) 342-1786
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C050266
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C050266
STATE LICENSE #
CA
01
—
W13226A
MEDICARE GROUP NUMBER
CA
01
—
ZZZ47948Z
BLUE SHIELD
CA
Enumeration date
07/18/2006
Last updated
04/06/2012
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