MEDICARE: SABRINA SANTA CLARA, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CP0097	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1740503267	OTHER	NV	NPPES - INDIVIDUAL NPI

General Provider Information

NPI Number	:	1235687575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SABRINA SANTA CLARA, PLLC

Provider Business Mailing Address
First Line	:	4252 VADER AVE
Second Line	:	STUDIO
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2138
Country	:	US
Telephone Number	:	951-378-5868
Fax Number	:

Provider Business Practice Location Address
First Line	:	4252 VADER AVE
Second Line	:	STUDIO
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2138
Country	:	US
Telephone Number	:	951-378-5868
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SABRINA SHIREEN SANTA CLARA
Credential	:	LCPC
Telephone Number	:	951-378-5868

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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