Basic Information
Provider Information
NPI: 1942609961
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIERRA
FirstName: BRANDI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 821 EL CAMINO REAL
Address2: APT. 305
City: BURLINGAME
State: CA
PostalCode: 940105062
CountryCode: US
TelephoneNumber: 6508179070
FaxNumber: 6502463838
Practice Location
Address1: 300 HARBOR BLVD
Address2: BUILDING E
City: BELMONT
State: CA
PostalCode: 940024018
CountryCode: US
TelephoneNumber: 6508179070
FaxNumber: 6502463838
Other Information
ProviderEnumerationDate: 08/14/2014
LastUpdateDate: 08/14/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X812495CAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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