Healthcare Provider Details

I. General information

NPI: 1114054186
Provider Name (Legal Business Name): LEAH D BRINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KAISER PERMANENTE PEDIATRICS 1375 EAST 20TH AVE
DENVER CO
80205
US

IV. Provider business mailing address

KAISER PERMANENTE PEDIATRICS 1375 EAST 20TH AVE
DENVER CO
80205
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-1233
  • Fax:
Mailing address:
  • Phone: 303-360-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number102579
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: