Healthcare Provider Details

I. General information

NPI: 1912831371
Provider Name (Legal Business Name): BRIANNA KATHY-CARRILLO WEISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 TOPEKA DR
TARZANA CA
91356-1316
US

IV. Provider business mailing address

7939 BOBBYBOYAR AVE
WEST HILLS CA
91304-4422
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-1424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: