Provider Demographics
NPI:1821428210
Name:TRAINER BERRY, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:TRAINER BERRY
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 1:8 PACIFIC CRST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5316
Mailing Address - Country:US
Mailing Address - Phone:714-580-4634
Mailing Address - Fax:657-888-6251
Practice Address - Street 1:1500 S SUNKIST ST
Practice Address - Street 2:SUITE D
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5815
Practice Address - Country:US
Practice Address - Phone:657-888-6250
Practice Address - Fax:657-888-6251
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO01856222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist