Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TH0100X | Health Service |
NPI | 1205505260 |
---|---|
Provider Name | Briana Michelle Powell |
First Address | Escondido, CA 92025-3079 |
Second Address | Escondido, CA 92025-3079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2021 |
Last Update Date | 12/09/2021 |