Healthcare Provider Details

I. General information

NPI: 1043151871
Provider Name (Legal Business Name): BRIAN DECAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14149 BUCHER AVE BLDG D
SYLMAR CA
91342-1442
US

IV. Provider business mailing address

7609 PONCE AVE
WEST HILLS CA
91304-5436
US

V. Phone/Fax

Practice location:
  • Phone: 747-999-4232
  • Fax: 818-479-7549
Mailing address:
  • Phone: 818-577-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: