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General NPI Number Information
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NPI Number | 1699197590
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Entity Type | Individual
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Provider Name | JACQUELINE ANN BRAZIL R.N.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2014
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Last Update Date | 01/11/2014
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Provider Practice Location Address
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Address Line | 3390 COUNTRY VILLAGE RD APT 2217
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City | RIVERSIDE
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State | CA
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Zip | 92509-1084
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Country | US
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Telephone | 951-403-8879
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3591
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City | RIVERSIDE
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State | CA
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Zip | 92519-3591
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Country | US
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Telephone | 951-403-8879
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Fax |
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 464833
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License Number State | CA
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