1396950556 NPI number — MS. GLENDA BRISBANE M.S.

Table of content: MS. GLENDA BRISBANE M.S. (NPI 1396950556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396950556 NPI number — MS. GLENDA BRISBANE M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRISBANE
Provider First Name:
GLENDA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396950556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2012 HUNTINGTON DR
Provider Second Line Business Mailing Address:
#6
Provider Business Mailing Address City Name:
SOUTH PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91030-4944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-226-5073
Provider Business Mailing Address Fax Number:
323-226-4417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LACUSC MEDICAL CENTER
Provider Second Line Business Practice Location Address:
2010 ZONAL AVE OPD ROOM 2P70
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-5073
Provider Business Practice Location Address Fax Number:
323-226-4417
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AU1136 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AU1136 . This is a "AUDIOLOGY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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