1831199017 NPI number — JOEY BRETT MD

Table of content: JOEY BRETT MD (NPI 1831199017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831199017 NPI number — JOEY BRETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRETT
Provider First Name:
JOEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1831199017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12400 VENTURA BLVD
Provider Second Line Business Mailing Address:
# 738
Provider Business Mailing Address City Name:
STUDIO CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91604-3606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-789-0034
Provider Business Mailing Address Fax Number:
818-789-0042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13320 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91423-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-789-0034
Provider Business Practice Location Address Fax Number:
818-789-0042
Provider Enumeration Date:
07/28/2005

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: 207Q00000X , with the licence number:  A055102 , 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: 00A551020 . This is a "MEDI-CAL RENDERING NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WA55102C . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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