Doctor Name: | MR. BLAKE BRISBOIS |
NPI Number: | 1669826723 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A. |
License Number: | PSB94021467 |
Business Practice Address: | 23622 Calabasas Rd Suite 301 Calabasas, CA - 913021549 |
Business Phone Number: | 8189214300 |
Business Fax Number: | 8779173450 |
Mailing Address: | 23622 Calabasas Rd, Suite 301 CALABASAS |
State: | CA |
Postal Code: | 913021549 |
Phone Number: | 8189214300 |
Fax Number: | 8779173450 |
NPI Enumeration Date: | 04/14/2016 |
NPI Last Update Date: | 04/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | PSB94021467 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |