Healthcare Provider Details

I. General information

NPI: 1487158671
Provider Name (Legal Business Name): EMILY ALLISON BRANDT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1083
US

IV. Provider business mailing address

1200 N STATE ST
LOS ANGELES CA
90033-1083
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-5707
  • Fax: 323-226-4380
Mailing address:
  • Phone: 323-409-5707
  • Fax: 323-226-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A17800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: