Provider Demographics
NPI:1326571803
Name:VIRGONA, BRIANNE M (CHES)
Entity Type:Individual
Prefix:MISS
First Name:BRIANNE
Middle Name:M
Last Name:VIRGONA
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 CARTER AVE
Mailing Address - Street 2:UNIT 219
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4944
Mailing Address - Country:US
Mailing Address - Phone:858-525-1309
Mailing Address - Fax:
Practice Address - Street 1:3221 CARTER AVE
Practice Address - Street 2:UNIT 219
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-4944
Practice Address - Country:US
Practice Address - Phone:858-525-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator