Healthcare Provider Details

I. General information

NPI: 1952881658
Provider Name (Legal Business Name): BRIANNE ELIZABETH VENRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 SYRACUSE AVE
STANTON CA
90680-1906
US

IV. Provider business mailing address

7140 SYRACUSE AVE
STANTON CA
90680-1906
US

V. Phone/Fax

Practice location:
  • Phone: 714-728-6732
  • Fax:
Mailing address:
  • Phone: 714-728-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: