Provider Demographics
NPI:1386320992
Name:SARMIENTO, BRIANNA MARIE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:SARMIENTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GLEN EYRIE AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3123
Mailing Address - Country:US
Mailing Address - Phone:408-640-6998
Mailing Address - Fax:408-640-6998
Practice Address - Street 1:51 GLEN EYRIE AVE APT 14
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3123
Practice Address - Country:US
Practice Address - Phone:408-640-6998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANAOtherMEDICAL
CANPIOtherNA