Healthcare Provider Details

I. General information

NPI: 1477457893
Provider Name (Legal Business Name): TINA LOUISE BRINDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 5TH ST
MODESTO CA
95351-3316
US

IV. Provider business mailing address

605 5TH ST
MODESTO CA
95351-3316
US

V. Phone/Fax

Practice location:
  • Phone: 209-341-0718
  • Fax:
Mailing address:
  • Phone: 209-341-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MKXJCD
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: