Individual
DAISY BRISENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2415 W VINE ST, SUITE 106, LODI, CA 95242-3731
(209) 333-3066
(209) 333-3065
Mailing address
PO BOX 241011, LODI, CA 95241-9511
(209) 339-7435
(209) 333-3054
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
810710
CA
363LF0000X
Family Nurse Practitioner
95003972
CA
Other
Enumeration date
01/04/2016
Last updated
04/04/2017
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