Healthcare Provider Details

I. General information

NPI: 1679482798
Provider Name (Legal Business Name): BRENT LEE HARDING CMPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1040
PINE GROVE CA
95665-1040
US

IV. Provider business mailing address

PO BOX 1040
PINE GROVE CA
95665-1040
US

V. Phone/Fax

Practice location:
  • Phone: 530-925-1347
  • Fax:
Mailing address:
  • Phone: 530-925-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: