Healthcare Provider Details

I. General information

NPI: 1942557772
Provider Name (Legal Business Name): MR. JOSEPH RAY BRINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

1950 S PALM CANYON DR UNIT 113
PALM SPRINGS CA
92264-8966
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8455
  • Fax:
Mailing address:
  • Phone: 310-622-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number74548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: