Provider Demographics
NPI:1881977312
Name:SIMS, BRANDE NICOLE (IDMT)
Entity type:Individual
Prefix:
First Name:BRANDE
Middle Name:NICOLE
Last Name:SIMS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S PACIFIC AVE
Mailing Address - Street 2:BLDG 30
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-8103
Mailing Address - Country:US
Mailing Address - Phone:310-653-8568
Mailing Address - Fax:310-653-0888
Practice Address - Street 1:605 HARVEST FIELD WAY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-3185
Practice Address - Country:US
Practice Address - Phone:310-424-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians