Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 21242 | CA |
NPI | 1295159218 |
---|---|
Provider Name | Dr. Sabrina Lee Berry |
First Address | Ladera Ranch, CA 92694-1249 |
Second Address | Ladera Ranch, CA 92694-1249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2014 |
Last Update Date | 11/02/2014 |