Provider Demographics
NPI:1558125450
Name:BROUSSARD, SILVIANN D (CPT 1)
Entity Type:Individual
Prefix:MS
First Name:SILVIANN
Middle Name:D
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:CPT 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37817 PEREGRINE PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7914
Mailing Address - Country:US
Mailing Address - Phone:424-204-2393
Mailing Address - Fax:
Practice Address - Street 1:37817 PEREGRINE PL
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7914
Practice Address - Country:US
Practice Address - Phone:424-204-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy