1881864502 NPI number — GAIL C. BRADY MD, A PROFESSIONAL

Table of content: (NPI 1881864502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881864502 NPI number — GAIL C. BRADY MD, A PROFESSIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAIL C. BRADY MD, A PROFESSIONAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1881864502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5046 COFLER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91607-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-789-7920
Provider Business Mailing Address Fax Number:
818-505-3814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S BEVERLY DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90212-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-601-4839
Provider Business Practice Location Address Fax Number:
818-505-3814
Provider Enumeration Date:
03/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRADY
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
310-601-4839

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  L016401 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: C51588 , 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: 1983772 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com