MEDICARE: DR. ROBERT RICARDO BRIONES PSY. D.

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	103TC0700X	Clinical Psychologist	PSY15198	CA

General Provider Information

NPI Number	:	1932425493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT RICARDO BRIONES PSY. D.

Provider Business Mailing Address
First Line	:	611 WILSHIRE BLVD STE 309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2908
Country	:	US
Telephone Number	:	818-636-1215
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 WILSHIRE BLVD STE 309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2908
Country	:	US
Telephone Number	:	213-506-9084
Fax Number	:

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

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	11/12/2019

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