Healthcare Provider Details

I. General information

NPI: 1598959611
Provider Name (Legal Business Name): STEVEN GREGORY BRODIE SR. M.S. PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 FALLBROOK AVE
WEST HILLS CA
91304-3226
US

IV. Provider business mailing address

20 MEDEA CREEK LN
OAK PARK CA
91377-1007
US

V. Phone/Fax

Practice location:
  • Phone: 818-737-6180
  • Fax:
Mailing address:
  • Phone: 818-917-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License NumberMTO471
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberMTP172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: