Provider Demographics
NPI:1508337650
Name:BERRYESSA, LEE ANN (RT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:BERRYESSA
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:ANN
Other - Last Name:BERRYESSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RCP
Mailing Address - Street 1:2813 BALFOR CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4911
Mailing Address - Country:US
Mailing Address - Phone:916-792-0861
Mailing Address - Fax:
Practice Address - Street 1:2813 BALFOR CT
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4911
Practice Address - Country:US
Practice Address - Phone:916-792-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132722279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care