Healthcare Provider Details

I. General information

NPI: 1992039572
Provider Name (Legal Business Name): SAYURI BRADY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W STE 1600
ORANGE CA
92868-5903
US

IV. Provider business mailing address

333 CITY BLVD W STE 1600
ORANGE CA
92868-5903
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number19183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: