Healthcare Provider Details

I. General information

NPI: 1992988794
Provider Name (Legal Business Name): BRENDA JOYCE FLUENCE RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W OLYMPIC BLVD
LOS ANGELES CA
90015-1329
US

IV. Provider business mailing address

10338 CROESUS AVE
LOS ANGELES CA
90002-3806
US

V. Phone/Fax

Practice location:
  • Phone: 213-861-5812
  • Fax:
Mailing address:
  • Phone: 323-566-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number00004563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: