Healthcare Provider Details

I. General information

NPI: 1386808624
Provider Name (Legal Business Name): DANIEL ITZHAK BRISON MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23929 MCBEAN PKWY
VALENCIA CA
91355-4466
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-290-5320
  • Fax: 661-290-5321
Mailing address:
  • Phone: 818-837-5637
  • Fax: 818-837-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA107310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: