Healthcare Provider Details

I. General information

NPI: 1639664295
Provider Name (Legal Business Name): SABRINA DEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/06/2024
Certification Date: 07/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 HAMNER AVE
EASTVALE CA
91752-1009
US

IV. Provider business mailing address

5030 HAMNER AVE
EASTVALE CA
91752-1009
US

V. Phone/Fax

Practice location:
  • Phone: 951-361-9092
  • Fax:
Mailing address:
  • Phone: 626-512-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33960TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: