Healthcare Provider Details

I. General information

NPI: 1356585038
Provider Name (Legal Business Name): BRIAN JOSEPH MAIN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 WEST CECIL AVENUE
DELANO CA
93215
US

IV. Provider business mailing address

PO BOX 5007
DELANO CA
93216-5007
US

V. Phone/Fax

Practice location:
  • Phone: 619-316-1466
  • Fax:
Mailing address:
  • Phone: 661-721-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: