Provider Demographics
NPI:1174726764
Name:SIEGFRIED, BRENDA MARIE (CMT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:SIEGFRIED
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:BRE
Other - Middle Name:
Other - Last Name:SIEGFRIED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:1340 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5240
Mailing Address - Country:US
Mailing Address - Phone:209-303-1902
Mailing Address - Fax:
Practice Address - Street 1:1609 TULLY RD
Practice Address - Street 2:SUITE #2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4062
Practice Address - Country:US
Practice Address - Phone:209-303-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath