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General NPI Number Information
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NPI Number | 1053711739
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Entity Type | Organization
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Legal Business Name | BRANDICE MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 08/29/2014
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Last Update Date | 08/29/2014
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Provider Practice Location Address
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Address Line | 13575 JASPER LOOP
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City | CORONA
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State | CA
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Zip | 92879
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Country | US
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Telephone | 951-340-1800
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Fax | 951-340-1824
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Provider Business Mailing Address
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Address Line | 1191 MAGNOLIA AVE STE. D-336
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City | CORONA
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State | CA
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Zip | 92879
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Country | US
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Telephone | 951-340-1800
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Fax | 951-340-1824
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARTIN J PRYAL
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Credential |
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Telephone | 951-340-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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