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General NPI Number Information
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NPI Number | 1174283428
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Entity Type | Individual
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Provider Name | MARCUS BRAZEL ACNP
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Gender | Male
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 3855 HEALTH SCIENCES DR
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City | LA JOLLA
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State | CA
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Zip | 92093-9000
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Country | US
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Telephone | 800-926-8273
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Fax |
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Provider Business Mailing Address
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Address Line | FILE 57326
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City | LOS ANGELES
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State | CA
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Zip | 90074-0001
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95019191
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License Number State | CA
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