Healthcare Provider Details

I. General information

NPI: 1043780737
Provider Name (Legal Business Name): TORI LYNNE BRANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANDIFORD AVE STE. 12-180
MODESTO CA
95350-6522
US

IV. Provider business mailing address

3716 TERNEUZEN AVE
MODESTO CA
95356-0735
US

V. Phone/Fax

Practice location:
  • Phone: 209-407-7138
  • Fax:
Mailing address:
  • Phone: 209-407-7138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: