Healthcare Provider Details

I. General information

NPI: 1174840953
Provider Name (Legal Business Name): MAC BRIAN STRELIOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S ARROYO PKWY STE. 100
PASADENA CA
91105-3911
US

IV. Provider business mailing address

25022 DOGWOOD CT
STEVENSON RANCH CA
91381-2211
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-4888
  • Fax:
Mailing address:
  • Phone: 661-254-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: