Individual
DR. BRANDIE LAUREN FIRETAG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3701 S HIGUERA ST, SAN LUIS OBISPO, CA 93401
(805) 541-6033
Mailing address
PO BOX 5007, SAN LUIS OBISPO, CA 93403-5007
(805) 710-7308
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
A112721
CA
207ZC0500X
Cytopathology Physician
A112721
CA
207ZP0101X
Anatomic Pathology Physician
Primary
A112721
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/12/2009
Last updated
06/21/2024
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