Healthcare Provider Details

I. General information

NPI: 1952550345
Provider Name (Legal Business Name): BRIAN CHRISTOPHER WREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST CLINICAL SOCIAL WORK
BURBANK CA
91505-4809
US

IV. Provider business mailing address

501 S BUENA VISTA ST CLINICAL SOCIAL WORK
BURBANK CA
91505-4809
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-4377
  • Fax:
Mailing address:
  • Phone: 818-847-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: