1558690677 NPI number — MS. LOIDA LIDA BRINCKHAUS FNP

Table of content: MS. LOIDA LIDA BRINCKHAUS FNP (NPI 1558690677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558690677 NPI number — MS. LOIDA LIDA BRINCKHAUS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINCKHAUS
Provider First Name:
LOIDA
Provider Middle Name:
LIDA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1558690677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 OCEANGATE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90802-4317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-499-6191
Provider Business Mailing Address Fax Number:
562-499-6171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24020 PRADO LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92324-9761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-954-4516
Provider Business Practice Location Address Fax Number:
909-737-6698
Provider Enumeration Date:
12/19/2009

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: 363LF0000X , with the licence number:  397281 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 5470 , 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)





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