Healthcare Provider Details

I. General information

NPI: 1659568285
Provider Name (Legal Business Name): BRITTANY FALLON PINHEIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31681 RIVERSIDE DR SUITE L
LAKE ELSINORE CA
92530-7815
US

IV. Provider business mailing address

31681 RIVERSIDE DR SUITE L
LAKE ELSINORE CA
92530-7815
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-9243
  • Fax: 951-674-9635
Mailing address:
  • Phone: 951-674-9243
  • Fax: 951-674-9635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number58396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: