Healthcare Provider Details

I. General information

NPI: 1639655152
Provider Name (Legal Business Name): BRIELLE ASHLIE BOCKOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 CENTRAL BLVD STE A
BRENTWOOD CA
94513-2379
US

IV. Provider business mailing address

5419 PIPER LN
OAKLEY CA
94561-3122
US

V. Phone/Fax

Practice location:
  • Phone: 925-809-6565
  • Fax:
Mailing address:
  • Phone: 925-809-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: