Healthcare Provider Details

I. General information

NPI: 1427502533
Provider Name (Legal Business Name): KELLY S BRIGNONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 PIONEER BLVD STE 215
SANTA FE SPRINGS CA
90670-8277
US

IV. Provider business mailing address

10330 PIONEER BLVD STE 215
SANTA FE SPRINGS CA
90670-8277
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0677
  • Fax:
Mailing address:
  • Phone: 562-402-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT93373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: