Provider Demographics
NPI:1053711739
Name:BRANDICE MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:BRANDICE MEDICAL ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-340-1800
Mailing Address - Street 1:1191 MAGNOLIA AVE
Mailing Address - Street 2:STE. D-336
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879
Mailing Address - Country:US
Mailing Address - Phone:951-340-1800
Mailing Address - Fax:951-340-1824
Practice Address - Street 1:13575 JASPER LOOP
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-340-1800
Practice Address - Fax:951-340-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory