Healthcare Provider Details

I. General information

NPI: 1689143356
Provider Name (Legal Business Name): MICHAEL BRENDZAL PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2018
Last Update Date: 11/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W GLENOAKS BLVD # 307
GLENDALE CA
91202-2896
US

IV. Provider business mailing address

501 W GLENOAKS BLVD # 307
GLENDALE CA
91202-2896
US

V. Phone/Fax

Practice location:
  • Phone: 626-818-1747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: