Provider Demographics
NPI:1891273223
Name:GASPORRA, BERLYN
Entity Type:Individual
Prefix:
First Name:BERLYN
Middle Name:
Last Name:GASPORRA
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 1:270 W SPARKLEBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-5012
Mailing Address - Country:US
Mailing Address - Phone:714-824-9312
Mailing Address - Fax:
Practice Address - Street 1:270 W SPARKLEBERRY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-5012
Practice Address - Country:US
Practice Address - Phone:714-824-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health