Provider Demographics
NPI:1245894237
Name:IRABOR, SHERI CLARA
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:CLARA
Last Name:IRABOR
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 1:8250 VINEYARD AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8703
Mailing Address - Country:US
Mailing Address - Phone:909-560-0017
Mailing Address - Fax:
Practice Address - Street 1:8250 VINEYARD AVE APT 24
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8703
Practice Address - Country:US
Practice Address - Phone:909-560-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT31658167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes167G00000XNursing Service ProvidersLicensed Psychiatric TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT31658OtherNA