Healthcare Provider Details

I. General information

NPI: 1801452511
Provider Name (Legal Business Name): BRIANNA COPELAND R. EEG T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CIVIC CENTER DR # 300
SAN RAFAEL CA
94903-4171
US

IV. Provider business mailing address

622 GOLDEN GATE AVE
RICHMOND CA
94801-3744
US

V. Phone/Fax

Practice location:
  • Phone: 628-877-0040
  • Fax:
Mailing address:
  • Phone: 909-856-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number6297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: