Healthcare Provider Details

I. General information

NPI: 1245507755
Provider Name (Legal Business Name): MARIANNE ELIZA BRICK D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8520 MADISON AVE
FAIR OAKS CA
95628-3809
US

IV. Provider business mailing address

8520 MADISON AVE
FAIR OAKS CA
95628-3809
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-1541
  • Fax: 916-961-8521
Mailing address:
  • Phone: 916-961-1541
  • Fax: 916-961-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number11176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: