Provider Demographics
NPI:1174880553
Name:BRANDOW, PRECIOSA M (MS,, PPS)
Entity type:Individual
Prefix:MRS
First Name:PRECIOSA
Middle Name:M
Last Name:BRANDOW
Suffix:
Gender:F
Credentials:MS,, PPS
Other - Prefix:MISS
Other - First Name:PRECIOSA
Other - Middle Name:M
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PPS
Mailing Address - Street 1:1060 E COOLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3924
Mailing Address - Country:US
Mailing Address - Phone:909-641-4909
Mailing Address - Fax:
Practice Address - Street 1:1060 E COOLEY DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3924
Practice Address - Country:US
Practice Address - Phone:909-641-4909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health