DR. SRBUI SABRINA DERTSAKYAN (NPI# 1366706806) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366706806 |
| Entity Type | Individual |
| Full Name | DR. SRBUI SABRINA DERTSAKYAN |
| Credential | M.A., PSY.D. |
| Practice Address |
1745 Enterprise Dr Fairfield CA 94533-5801 |
| Mailing Address |
900 N Church St Lodi CA 95240-1282 |
| Practice Telephone | 5103184461 |
| Practice Fax Number | 7074194952 |
| Mailing Telephone | 2093331222 |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-12-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TA0700X |
Psychologist Specialization: Adult Development & Aging |
CA | Behavioral Health & Social Service Providers |
| Street Address |
1745 ENTERPRISE DR |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94533-5801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558435230 | Tomikka Kimberly Lee | Social Worker | 1745 Enterprise Dr, V110 Bldg 2, Fairfield, CA 94533-5801 | 2006-11-17 |
| 1275150286 | Patricia Baker | Counselor | 1745 Enterprise Dr, Fairfield, CA 94533-5801 | 2020-06-25 |
| 1669097457 | Dina L Sandersmayfield | Counselor | 1745 Enterprise Dr, Fairfield, CA 94533-5801 | 2020-06-08 |
| 1881066769 | Autumn Makamson | Social Worker | 1745 Enterprise Dr, Fairfield, CA 94533-5801 | 2015-10-30 |
| 1376924910 | Sofia Herrera | Social Worker | 1745 Enterprise Dr, Bldg 2, First Floor, Suite V110, Fairfield, CA 94533-5801 | 2015-06-09 |
| 1649657248 | Agape Counseling Center and Network | Community/Behavioral Health | 1745 Enterprise Dr, Bldg 2, Fairfield, CA 94533-5801 | 2015-05-04 |
| 1841523719 | Heather Doumbia | Counselor | 1745 Enterprise Dr, Fairfield, CA 94533-5801 | 2009-09-10 |
| 1245480862 | Patricia Ann Boykin | Student in an Organized Health Care Education/Training Program | 1745 Enterprise Dr, Building 2, I-64, Fairfield, CA 94533-5801 | 2008-09-19 |
| 1649439233 | Reggie A Smith | Counselor | 1745 Enterprise Dr, Fairfield, CA 94533-5801 | 2008-06-09 |
| 1881865384 | Virginia Barraza | Marriage & Family Therapist | 1745 Enterprise Dr, Fairfield, CA 94533-5801 | 2008-03-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609487347 | Shayondelice Sledge | Case Manager/Care Coordinator | 3001 N. Texas St., #27, Fairfield, CA 94533 | 2020-08-16 |
| 1508401191 | Tiffany Ann Garcia | Social Worker | 1301 Roman Way, Martinez, CA 94533 | 2019-11-07 |
| 1609424175 | Andrew Stephens | Student in an Organized Health Care Education/Training Program | Dgmc, 101 Bodin Cir, Fairfield, CA 94533 | 2019-08-28 |
| 1821645383 | Michelle Marie Hackett | Marriage & Family Therapist | 1745 Enterprise Dr., Bldg. 2, Ste 1a, Fairfield, CA 94533 | 2019-08-20 |
| 1780154369 | Maria Leonila Ramos Corpuz | Behavior Technician | 744 Empire Street Suite 160, Fairfield, CA 94533 | 2018-11-27 |
| 1629575303 | Jeanne Ann Kiernan | Dentist | 690 Airman Dr, Apo, AA 94533 | 2018-04-10 |
| 1629596820 | Max Kardos | Student in an Organized Health Care Education/Training Program | 801 Empire St., Fairfield, CA 94533 | 2017-09-07 |
| 1780119867 | Justin Denhart Dickson | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir Fairfield Ca 94533, David Grant Medical Center, Fpo, AA 94533 | 2017-04-26 |
| 1639613409 | Behrooz Shafiezadeh | Marriage & Family Therapist | Caminar, 601 Madison Street, Suite D, Fairfield, CA 94533 | 2016-12-13 |
| 1427500164 | Tanya Ayers | Counselor | 801 Empire Street, Fairfield, CA 94533 | 2016-10-28 |
| Find all providers in zip 94533 | ||||
| Taxonomy Code | 103TA0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Adult Development & Aging |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538708334 | Wright Conscious Counseling, A Psychological Corporation | Psychologist | 26895 Aliso Creek Rd Ste B160, Aliso Viejo, CA 92656-5301 | 2019-12-27 |
| 1720632631 | Efren Esparza | Psychologist | 525 Cabrillo Park Dr Ste 300525, Santa Ana, CA 92701-5017 | 2019-07-29 |
| 1649742479 | Cristina Ambos Wilson | Psychologist | 108 Holly Way, Pismo Beach, CA 93449-3221 | 2018-12-18 |
| 1871097311 | Chelsea By The Sea | Psychologist | 10211 Kukui Dr, Huntington Beach, CA 92646-2518 | 2018-03-20 |
| 1033636501 | Khachik Petrosyan | Psychologist | 1225 Oakridge Dr, Glendale, CA 91205-3412 | 2017-08-25 |
| 1891151213 | Shyma El Sayed | Psychologist | 1029 H St, 403, Sacramento, CA 95814-2847 | 2016-01-14 |
| 1720450638 | Nicholas Anderson | Psychologist | 2901 S Sepulveda Blvd Apt 206, Los Angeles, CA 90064-3946 | 2015-10-30 |
| 1669864302 | T. Adelstein, Ph.d., Psychologist, P.C. | Psychologist | 150 Morning Sun Ave, Mill Valley, CA 94941-3507 | 2015-03-03 |
| 1801292974 | Michelle R. Ancharoff | Psychologist | 4281 Katella Ave #122, Los Alamitos, CA 90720 | 2014-11-17 |
| 1619399052 | Kerry Hubel | Psychologist | 480 N 1st St, San Jose, CA 95112-4043 | 2014-01-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.