Individual
MRS. BRIANA LAUREN BOURBON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1700 COFFEE RD # 1, MODESTO, CA 95355-2803
(209) 572-7251
Mailing address
1700 COFFEE RD # 1, MODESTO, CA 95355-2803
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
65708
CA
Other
Enumeration date
11/13/2024
Last updated
01/16/2025
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