Healthcare Provider Details

I. General information

NPI: 1821428210
Provider Name (Legal Business Name): PAMELA TRAINER BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S SUNKIST ST SUITE D
ANAHEIM CA
92806-5815
US

IV. Provider business mailing address

8 PACIFIC CRST
LAGUNA NIGUEL CA
92677-5316
US

V. Phone/Fax

Practice location:
  • Phone: 657-888-6250
  • Fax: 657-888-6251
Mailing address:
  • Phone: 714-580-4634
  • Fax: 657-888-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO01856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: