Healthcare Provider Details

I. General information

NPI: 1932425493
Provider Name (Legal Business Name): ROBERT RICARDO BRIONES PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 WILSHIRE BLVD STE 309
LOS ANGELES CA
90017-2908
US

IV. Provider business mailing address

611 WILSHIRE BLVD STE 309
LOS ANGELES CA
90017-2908
US

V. Phone/Fax

Practice location:
  • Phone: 213-506-9084
  • Fax:
Mailing address:
  • Phone: 818-636-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: