Healthcare Provider Details

I. General information

NPI: 1396120093
Provider Name (Legal Business Name): BRISBEN MED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 COMMERCE AVE STE. E
PALMDALE CA
93551-3881
US

IV. Provider business mailing address

PO BOX 990
SANTA CLARITA CA
91380-9090
US

V. Phone/Fax

Practice location:
  • Phone: 800-239-2947
  • Fax:
Mailing address:
  • Phone: 800-239-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number76085
License Number StateCA

VIII. Authorized Official

Name: MRS. FLOR ORELLANA
Title or Position: CEO/PRESIDENT
Credential:
Phone: 800-239-2947