Healthcare Provider Details

I. General information

NPI: 1689375586
Provider Name (Legal Business Name): BRIANA LEE HERNANDEZ ARREDONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 S BROADWAY
SANTA MARIA CA
93454-7817
US

IV. Provider business mailing address

2029 LASSEN DR
SANTA MARIA CA
93458-8324
US

V. Phone/Fax

Practice location:
  • Phone: 805-925-6404
  • Fax: 805-928-9542
Mailing address:
  • Phone: 805-345-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number177329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: