Healthcare Provider Details

I. General information

NPI: 1841705225
Provider Name (Legal Business Name): BRETT RICHARD PADDEN RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

PO BOX 1664
FRAZIER PARK CA
93225-1664
US

V. Phone/Fax

Practice location:
  • Phone: 808-847-6332
  • Fax:
Mailing address:
  • Phone: 661-706-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number7527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: