Healthcare Provider Details

I. General information

NPI: 1740921899
Provider Name (Legal Business Name): BRANDY DAGNINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 SATURN ST STE 102
BREA CA
92821-6281
US

IV. Provider business mailing address

9632 CEDARTREE RD
DOWNEY CA
90240-2510
US

V. Phone/Fax

Practice location:
  • Phone: 657-444-9002
  • Fax:
Mailing address:
  • Phone: 310-480-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: