Healthcare Provider Details

I. General information

NPI: 1841591690
Provider Name (Legal Business Name): DAVID E. BRODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 SOUTH BLOOMFIELD AVE
NORWALK CA
90650
US

IV. Provider business mailing address

13200 SOUTH BLOOMFIELD AVE
NORWALK CA
90650
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-9979
  • Fax: 562-929-2629
Mailing address:
  • Phone: 562-868-9979
  • Fax: 562-929-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberCAC28885
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberCA28885
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberCA28885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: