Provider Demographics
NPI:1235687575
Name:SABRINA SANTA CLARA, PLLC
Entity Type:Organization
Organization Name:SABRINA SANTA CLARA, PLLC
Other - Org Name:CENTERS FOR INTEGRATED WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:SHIREEN
Authorized Official - Last Name:SANTA CLARA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:951-378-5868
Mailing Address - Street 1:4252 VADER AVE
Mailing Address - Street 2:STUDIO
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2138
Mailing Address - Country:US
Mailing Address - Phone:951-378-5868
Mailing Address - Fax:
Practice Address - Street 1:4252 VADER AVE
Practice Address - Street 2:STUDIO
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2138
Practice Address - Country:US
Practice Address - Phone:951-378-5868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0097101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1740503267OtherNPPES - INDIVIDUAL NPI