Healthcare Provider Details

I. General information

NPI: 1508561879
Provider Name (Legal Business Name): BRENDA ASILNEJAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST CLINIC TOWER A7D
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

472 N BOWLING GREEN WAY
LOS ANGELES CA
90049-2820
US

V. Phone/Fax

Practice location:
  • Phone: 310-991-9572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA197122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: