Healthcare Provider Details

I. General information

NPI: 1477904878
Provider Name (Legal Business Name): JOSHUA BRINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 WINDSOR DR
SAN BERNARDINO CA
92404-5416
US

IV. Provider business mailing address

9808 VENICE BLVD STE 505
CULVER CITY CA
90232-6818
US

V. Phone/Fax

Practice location:
  • Phone: 909-361-6470
  • Fax:
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-945-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: