Provider Demographics
NPI:1700085206
Name:BATES, SHERRI ELLEN (RD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:ELLEN
Last Name:BATES
Suffix:
Gender:F
Credentials:RD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N HARBOR BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4127
Mailing Address - Country:US
Mailing Address - Phone:626-437-6360
Mailing Address - Fax:
Practice Address - Street 1:5616 E BAY SHORE WALK
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4403
Practice Address - Country:US
Practice Address - Phone:626-437-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17593103TH0004X
CA715392133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered