Healthcare Provider Details

I. General information

NPI: 1861163792
Provider Name (Legal Business Name): BRIANNA ELIZABETH GAITAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 ARLINGTON AVE STE C
RIVERSIDE CA
92504-1966
US

IV. Provider business mailing address

6711 ARLINGTON AVE STE C
RIVERSIDE CA
92504-1966
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-4964
  • Fax:
Mailing address:
  • Phone: 951-352-4964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: