Provider Demographics
NPI:1851046965
Name:AUDELO, BRIANNA MERCEDES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:MERCEDES
Last Name:AUDELO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2904
Mailing Address - Country:US
Mailing Address - Phone:909-301-0141
Mailing Address - Fax:
Practice Address - Street 1:3841 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2904
Practice Address - Country:US
Practice Address - Phone:909-301-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor