Healthcare Provider Details

I. General information

NPI: 1437821717
Provider Name (Legal Business Name): ELIZABETH BRISENO I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 CRENSHAW BLVD STE E100
TORRANCE CA
90503-1728
US

IV. Provider business mailing address

370 CRENSHAW BLVD STE E100
TORRANCE CA
90503-1728
US

V. Phone/Fax

Practice location:
  • Phone: 310-787-1500
  • Fax:
Mailing address:
  • Phone: 310-787-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: