MEDICARE: BRIAN DECAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1043151871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DECAL

Provider Business Mailing Address
First Line	:	7609 PONCE AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-5436
Country	:	US
Telephone Number	:	818-577-3281
Fax Number	:

Provider Business Practice Location Address
First Line	:	14149 BUCHER AVE BLDG D
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-1442
Country	:	US
Telephone Number	:	747-999-4232
Fax Number	:	818-479-7549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2026
Last Update Date	:	04/06/2026

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Directions to “ BRIAN DECAL ” Practice Location

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