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General NPI Number Information
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NPI Number | 1033900733
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Entity Type | Individual
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Provider Name | BRICE MCKEOWN
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Gender | Male
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD BLDG 500
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-268-3776
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Fax |
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Provider Business Mailing Address
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Address Line | 550 S BARRINGTON AVE APT 4117
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City | LOS ANGELES
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State | CA
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Zip | 90049-4341
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Country | US
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Telephone | 805-791-7960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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