Provider Demographics
NPI:1154938819
Name:SKELTON, SABRINA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:SKELTON
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 1:2855 PINECREEK DR APT C413
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7474
Mailing Address - Country:US
Mailing Address - Phone:714-306-1211
Mailing Address - Fax:
Practice Address - Street 1:2855 PINECREEK DR APT C413
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7474
Practice Address - Country:US
Practice Address - Phone:714-306-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist