Provider Demographics
NPI:1801452511
Name:COPELAND, BRIANNA (R EEG T)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:R EEG T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3744
Mailing Address - Country:US
Mailing Address - Phone:909-856-1248
Mailing Address - Fax:
Practice Address - Street 1:4000 CIVIC CENTER DR # 300
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4171
Practice Address - Country:US
Practice Address - Phone:628-877-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
CA246ZE0600X
CA6297246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No156F00000XEye and Vision Services ProvidersTechnician/Technologist