Healthcare Provider Details

I. General information

NPI: 1144144932
Provider Name (Legal Business Name): BRIANNA RUTH ALCANTAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43585 MONTEREY AVE STE 1
PALM DESERT CA
92260-9398
US

IV. Provider business mailing address

47431 MARGARITA ST
INDIO CA
92201-6938
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-7720
  • Fax:
Mailing address:
  • Phone: 760-289-8769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: