Healthcare Provider Details

I. General information

NPI: 1467997668
Provider Name (Legal Business Name): ELISE BRIMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 WELCH RD 2ND FLOOR NEUROLOGY CC71015
PALO ALTO CA
94304-1503
US

IV. Provider business mailing address

730 WELCH RD 2ND FLOOR NEUROLOGY CC71015
PALO ALTO CA
94304-1503
US

V. Phone/Fax

Practice location:
  • Phone: 415-837-8454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: