Healthcare Provider Details

I. General information

NPI: 1104155761
Provider Name (Legal Business Name): BRENT ARTHUR NORTH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12408 HESPERIA RD SUITE 2
VICTORVILLE CA
92395-7718
US

IV. Provider business mailing address

12370 HESPERIA RD SUITE 6
VICTORVILLE CA
92395-7719
US

V. Phone/Fax

Practice location:
  • Phone: 760-553-7000
  • Fax: 760-269-1282
Mailing address:
  • Phone: 760-245-4747
  • Fax: 760-269-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: