1235532441 NPI number — MISS BERLY NEWBERRY ADMINISTRATOR

Table of content: MISS BERLY NEWBERRY ADMINISTRATOR (NPI 1235532441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235532441 NPI number — MISS BERLY NEWBERRY ADMINISTRATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWBERRY
Provider First Name:
BERLY
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ADMINISTRATOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWBERRY
Provider Other First Name:
BERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
ADMINISTRATOR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235532441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1324 GREENWAY RISE
Provider Second Line Business Mailing Address:
1324 GREENWAY RISE
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92027-1169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-888-3064
Provider Business Mailing Address Fax Number:
858-939-9170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1324 GREENWAY RISE
Provider Second Line Business Practice Location Address:
1324 GREENWAY RISE
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92027-1169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-888-3064
Provider Business Practice Location Address Fax Number:
858-939-9170
Provider Enumeration Date:
10/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  3746033321 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WR0400X , with the licence number: 4746033321 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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