Healthcare Provider Details

I. General information

NPI: 1699683284
Provider Name (Legal Business Name): SERGIO MIGUEL VELOSO BRILHANTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 FRANCES AVE
FULLERTON CA
92831-1808
US

IV. Provider business mailing address

78 SEVILLE
TUSTIN CA
92780-5958
US

V. Phone/Fax

Practice location:
  • Phone: 949-529-8942
  • Fax:
Mailing address:
  • Phone: 949-664-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: