Provider Demographics
NPI:1437973211
Name:TUCKER, BRIANNA (MS, CGC)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 S SEPULVEDA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1744
Mailing Address - Country:US
Mailing Address - Phone:626-599-6504
Mailing Address - Fax:
Practice Address - Street 1:2440 S SEPULVEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1744
Practice Address - Country:US
Practice Address - Phone:626-599-6504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001826170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS