Healthcare Provider Details

I. General information

NPI: 1366013195
Provider Name (Legal Business Name): GEMILYN E BRINGAS BSN, RN, PHN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE RM 1190
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

2450 ASHBY AVE RM 1190
BERKELEY CA
94705-2067
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-6546
  • Fax: 510-204-6005
Mailing address:
  • Phone: 510-204-6546
  • Fax: 510-204-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number520528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: