Provider Demographics
NPI:1982387221
Name:BRAINCOM ADVANCED NURSING CORPORATION
Entity type:Organization
Organization Name:BRAINCOM ADVANCED NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:951-545-1149
Mailing Address - Street 1:765 N MAIN ST # 131-B17
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-1440
Mailing Address - Country:US
Mailing Address - Phone:951-545-1149
Mailing Address - Fax:
Practice Address - Street 1:1003 E COOLEY DR STE 211
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3907
Practice Address - Country:US
Practice Address - Phone:951-545-1149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty