Healthcare Provider Details

I. General information

NPI: 1275886400
Provider Name (Legal Business Name): BERNITA BRAZIER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LOMA VISTA RD SUITE 12
VENTURA CA
93003-3033
US

IV. Provider business mailing address

3400 LOMA VISTA RD SUITE 12
VENTURA CA
93003-3033
US

V. Phone/Fax

Practice location:
  • Phone: 805-850-0198
  • Fax:
Mailing address:
  • Phone: 805-850-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number221057
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number101006
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number5170
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number28407
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number5170
License Number StateCA

VIII. Authorized Official

Name: MISS BERNITA S BRAZIER
Title or Position: OWNER
Credential: NCBMTB, RNC, BS
Phone: 805-901-6832