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General NPI Number Information
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NPI Number | 1356652929
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Entity Type | Individual
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Provider Name | MARYELLEN BRISSON AU.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 4201 TORRANCE BLVD STE 140
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City | TORRANCE
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State | CA
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Zip | 90503-4500
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Country | US
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Telephone | 310-540-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 255 30TH ST
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2308
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Country | US
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Telephone | 310-372-2401
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AU604
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License Number State | CA
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