Provider Demographics
NPI:1689375586
Name:ARREDONDO, BRIANA LEE HERNANDEZ
Entity Type:Individual
Prefix:
First Name:BRIANA LEE
Middle Name:HERNANDEZ
Last Name:ARREDONDO
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 1:2029 LASSEN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-8324
Mailing Address - Country:US
Mailing Address - Phone:805-345-5272
Mailing Address - Fax:
Practice Address - Street 1:2405 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7817
Practice Address - Country:US
Practice Address - Phone:805-925-6404
Practice Address - Fax:805-928-9542
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177329183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician