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General NPI Number Information
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NPI Number | 1275989717
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Entity Type | Individual
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Provider Name | DEREK IZAK BRINK D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 3190 CHURN CREEK RD
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City | REDDING
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State | CA
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Zip | 96002-2122
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Country | US
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Telephone | 530-223-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 2139 VIENNA WAY
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City | REDDING
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State | CA
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Zip | 96003-9324
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Country | US
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Telephone | 530-701-2875
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 20A18109
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License Number State | CA
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