Provider Demographics
NPI:1952881658
Name:VENRICK, BRIANNE ELIZABETH
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:VENRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 SYRACUSE AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-1906
Mailing Address - Country:US
Mailing Address - Phone:714-728-6732
Mailing Address - Fax:
Practice Address - Street 1:7140 SYRACUSE AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-1906
Practice Address - Country:US
Practice Address - Phone:714-728-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program