Provider Demographics
NPI:1982387221
Name:BRAINCOM ADVANCED NURSING CORPORATION
Entity Type:Organization
Organization Name:BRAINCOM ADVANCED NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:951-545-1149
Mailing Address - Street 1:370 W GRAND BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2175
Mailing Address - Country:US
Mailing Address - Phone:951-545-1149
Mailing Address - Fax:
Practice Address - Street 1:370 W GRAND BLVD STE 207
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2175
Practice Address - Country:US
Practice Address - Phone:951-545-1149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty