Healthcare Provider Details

I. General information

NPI: 1770710501
Provider Name (Legal Business Name): BRIAN HURLEY MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 SANTA MONICA BLVD STE 105
LOS ANGELES CA
90025-7613
US

IV. Provider business mailing address

10940 WILSHIRE BLVD STE 710 C/O CHRISTINA PUNZALAN
LOS ANGELES CA
90095-7394
US

V. Phone/Fax

Practice location:
  • Phone: 310-903-9653
  • Fax: 310-382-2089
Mailing address:
  • Phone: 323-457-3675
  • Fax: 310-382-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number130543
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number130543
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number130543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: