Provider Demographics
NPI:1790302859
Name:GARCIA CUPP, BRIEL LA NAE
Entity Type:Individual
Prefix:MS
First Name:BRIEL
Middle Name:LA NAE
Last Name:GARCIA CUPP
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRIEL
Other - Middle Name:LA NAE
Other - Last Name:RASCON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11776 MARIPOSA RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1622
Mailing Address - Country:US
Mailing Address - Phone:760-956-2462
Mailing Address - Fax:760-956-7542
Practice Address - Street 1:11776 MARIPOSA RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1622
Practice Address - Country:US
Practice Address - Phone:760-956-2462
Practice Address - Fax:760-956-7542
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)