Provider Demographics
NPI:1982214359
Name:TEMPLE, BRANDI RAE
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:RAE
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:RAE
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11662 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5057
Mailing Address - Country:US
Mailing Address - Phone:951-333-9793
Mailing Address - Fax:
Practice Address - Street 1:11662 INWOOD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5057
Practice Address - Country:US
Practice Address - Phone:951-333-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty