Healthcare Provider Details

I. General information

NPI: 1982775565
Provider Name (Legal Business Name): MS. BRIGETTE NICOLE FAIETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/21/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 HIGH STREET
COLOMA CA
95613
US

IV. Provider business mailing address

PO BOX 330
COLOMA CA
95613-0330
US

V. Phone/Fax

Practice location:
  • Phone: 530-333-7043
  • Fax:
Mailing address:
  • Phone: 530-333-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT7612
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: