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General NPI Number Information
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NPI Number | 1215360037
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Entity Type | Individual
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Provider Name | BRANDON P URIBE NP
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Gender | Male
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 160 S SEVENTH AVE
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City | LA PUENTE
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State | CA
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Zip | 91773
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Country | US
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Telephone | 626-961-8971
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Fax |
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Provider Business Mailing Address
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Address Line | 160 S 7TH AVE
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City | LA PUENTE
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State | CA
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Zip | 91746-3211
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Country | US
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Telephone | 626-961-8971
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Fax | 626-961-6685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 836890
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95001944
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License Number State | CA
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