Provider Demographics
NPI:1235532441
Name:NEWBERRY, BERLY (ADMINISTRATOR)
Entity Type:Individual
Prefix:MISS
First Name:BERLY
Middle Name:
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:MISS
Other - First Name:BERLY
Other - Middle Name:
Other - Last Name:NEWBERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADMINISTRATOR
Mailing Address - Street 1:1324 GREENWAY RISE
Mailing Address - Street 2:1324 GREENWAY RISE
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-1169
Mailing Address - Country:US
Mailing Address - Phone:858-888-3064
Mailing Address - Fax:858-939-9170
Practice Address - Street 1:1324 GREENWAY RISE
Practice Address - Street 2:1324 GREENWAY RISE
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-1169
Practice Address - Country:US
Practice Address - Phone:858-888-3064
Practice Address - Fax:858-939-9170
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3746033321163WH0200X
CA4746033321163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation