Provider Demographics
NPI:1588281968
Name:PEDRO, BRIANA ELYSE (LVN)
Entity type:Individual
Prefix:MRS
First Name:BRIANA
Middle Name:ELYSE
Last Name:PEDRO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MISS
Other - First Name:BRIANA
Other - Middle Name:ELYSE
Other - Last Name:ISQUIRDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:20271 RHINESTONE DR
Mailing Address - Street 2:
Mailing Address - City:HILMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95324-9370
Mailing Address - Country:US
Mailing Address - Phone:209-413-5123
Mailing Address - Fax:
Practice Address - Street 1:4441 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3604
Practice Address - Country:US
Practice Address - Phone:559-600-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293053164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse