Healthcare Provider Details

I. General information

NPI: 1184381113
Provider Name (Legal Business Name): SHERRI RANDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 RAMONA EXPY STE 1
PERRIS CA
92571-7014
US

IV. Provider business mailing address

85 RAMONA EXPY STE 1
PERRIS CA
92571-7014
US

V. Phone/Fax

Practice location:
  • Phone: 951-349-4195
  • Fax: 951-490-0123
Mailing address:
  • Phone: 951-349-4195
  • Fax: 951-490-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: