Healthcare Provider Details

I. General information

NPI: 1316498926
Provider Name (Legal Business Name): MISS MARIA OTILIA MONROE-BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18700 OXNARD ST
TARZANA CA
91356-1413
US

IV. Provider business mailing address

18700 OXNARD ST
TARZANA CA
91356-1413
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax: 818-345-3778
Mailing address:
  • Phone: 818-996-1051
  • Fax: 818-345-3778

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: