Healthcare Provider Details

I. General information

NPI: 1043337686
Provider Name (Legal Business Name): ALEX FLOREZ BRIENING INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEX FLOREZ BRIENING INTERN

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE 1904 RICLAND AVE
CERES CA
95307-4562
US

IV. Provider business mailing address

10207 STATE HIGHWAY 33 10207 HIGHWAY 33
PATTERSON CA
95363-9452
US

V. Phone/Fax

Practice location:
  • Phone: 209-541-2121
  • Fax:
Mailing address:
  • Phone: 209-894-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: