Provider Demographics
NPI:1437654167
Name:BRISCOE, JANINE NICOLE
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:NICOLE
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 E FOOTHILL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RANCHO CUCCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739
Mailing Address - Country:US
Mailing Address - Phone:909-689-4135
Mailing Address - Fax:
Practice Address - Street 1:612 S MYRTLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3406
Practice Address - Country:US
Practice Address - Phone:909-689-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician