Healthcare Provider Details

I. General information

NPI: 1306443395
Provider Name (Legal Business Name): SABRINA JEAN STINNETT DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5182
US

IV. Provider business mailing address

7263 TEASDALE AVE
SAN DIEGO CA
92122-2828
US

V. Phone/Fax

Practice location:
  • Phone: 760-633-6501
  • Fax:
Mailing address:
  • Phone: 520-330-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number86276840
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: