Healthcare Provider Details

I. General information

NPI: 1003562034
Provider Name (Legal Business Name): BRITTANY LARISSA DE ANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 J ST
EUREKA CA
95501-3055
US

IV. Provider business mailing address

2100 J ST
EUREKA CA
95501-3055
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-2400
  • Fax:
Mailing address:
  • Phone: 707-441-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: