Provider Demographics
NPI:1205017001
Name:BRANDI PARIS
Entity Type:Organization
Organization Name:BRANDI PARIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-435-1904
Mailing Address - Street 1:3176 PULLMAN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3317
Mailing Address - Country:US
Mailing Address - Phone:714-435-1904
Mailing Address - Fax:714-435-1964
Practice Address - Street 1:3176 PULLMAN ST STE 104
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3317
Practice Address - Country:US
Practice Address - Phone:714-435-1904
Practice Address - Fax:714-435-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97188332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02371FMedicaid
CA1101620001Medicare NSC