Healthcare Provider Details

I. General information

NPI: 1871828301
Provider Name (Legal Business Name): KIM Y BRANTLEY CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32256 VIA ARIAS
TEMECULA CA
92592-3873
US

IV. Provider business mailing address

32256 VIA ARIAS
TEMECULA CA
92592-3873
US

V. Phone/Fax

Practice location:
  • Phone: 951-373-3080
  • Fax:
Mailing address:
  • Phone: 951-373-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number88040
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number211253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: