Healthcare Provider Details

I. General information

NPI: 1477721710
Provider Name (Legal Business Name): AYDEE LEON BRIONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 BEAR MOUNTAIN BLVD
ARVIN CA
93203-1231
US

IV. Provider business mailing address

PO BOX 1559
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 661-854-3131
  • Fax: 661-854-2689
Mailing address:
  • Phone: 661-397-8775
  • Fax: 661-397-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW #75611
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW #34241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: