Provider Demographics
NPI:1700113420
Name:FALCON, BRANDY C (LAC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:C
Last Name:FALCON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 FARM HILL BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-1039
Mailing Address - Country:US
Mailing Address - Phone:408-406-2642
Mailing Address - Fax:
Practice Address - Street 1:4020 FARM HILL BLVD APT 2
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-1039
Practice Address - Country:US
Practice Address - Phone:408-406-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13168171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist