Basic Information
| Provider Information | |||||||||
| NPI: | 1689247926 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRANDI FLORES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2212 ESMOND AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948012597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103342412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2212 ESMOND AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948012597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103342412 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2021 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | FLORES | ||||||||
| AuthorizedOfficialFirstName: | BRANDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | IBCLC | ||||||||
| AuthorizedOfficialTelephone: | 5103342412 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | IBCLC | ||||||||
| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 174N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Lactation Consultant, Non-RN |
No ID Information.