Individual
MR. BRANDAN CHACE MORONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9981 SPRING VALLEY RD, POTTER VALLEY, CA 95469-9713
(707) 467-2010
Mailing address
PO BOX 2077, UKIAH, CA 95482-2077
(707) 467-2010
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
697568
CA
164X00000X
Licensed Vocational Nurse
Primary
697568
CA
171M00000X
Case Manager/Care Coordinator
697568
CA
Other
Enumeration date
02/23/2007
Last updated
02/14/2020
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