Provider Demographics
NPI:1598315285
Name:SANABRIA, BETTY M
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:M
Last Name:SANABRIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12168 MOUNT VERNON AVE UNIT 25
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5541
Mailing Address - Country:US
Mailing Address - Phone:909-554-0733
Mailing Address - Fax:
Practice Address - Street 1:12168 MOUNT VERNON AVE UNIT 25
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5541
Practice Address - Country:US
Practice Address - Phone:909-554-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider