Healthcare Provider Details

I. General information

NPI: 1760797484
Provider Name (Legal Business Name): MR. MICHAEL BRIBEAUX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 07/07/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E FOOTHILL BLVD STE 102
ARCADIA CA
91006-2361
US

IV. Provider business mailing address

41 E FOOTHILL BLVD STE 102
ARCADIA CA
91006-2361
US

V. Phone/Fax

Practice location:
  • Phone: 626-701-4249
  • Fax: 626-737-6034
Mailing address:
  • Phone: 626-701-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number82183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: