Provider Demographics
NPI:1154527646
Name:COLLINS, BRANDIE A (IDC)
Entity type:Individual
Prefix:MS
First Name:BRANDIE
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GRAPEVINE RD
Mailing Address - Street 2:#205
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-4038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 GRAPEVINE RD
Practice Address - Street 2:#205
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-4038
Practice Address - Country:US
Practice Address - Phone:901-874-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital