Most Relevant Information
Provider Data
| NPI Number: | 1003354010 |
| Provider Name: | NICAEA BERRY CCMA |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: | 16114-16 |
Most Important Dates
| Enumeration Date: | 02/09/2017 |
| Last Updated: | 02/09/2023 |
Provider Practice Location
349A E AVENUE K6
LANCASTER
CA
935354548
Practice Location Phone/Fax
| Phone: | 6617234260 |
| Fax: |
Provider Mailing Location
349A E AVENUE K6
LANCASTER
CA
935354548
Provider Mailing Phone/Fax
| Phone: | 6617234260 |
| Fax: |