Provider Demographics
NPI:1730792029
Name:BRIGHTLANE OF CALIFORNIA
Entity type:Organization
Organization Name:BRIGHTLANE OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIZOL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-780-2907
Mailing Address - Street 1:503 1/2 S MYRTLE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5101
Mailing Address - Country:US
Mailing Address - Phone:800-780-2907
Mailing Address - Fax:323-760-7224
Practice Address - Street 1:503 1/2 S MYRTLE AVE # 3
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5101
Practice Address - Country:US
Practice Address - Phone:800-780-2907
Practice Address - Fax:323-760-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health