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General NPI Number Information
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NPI Number | 1558690677
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Entity Type | Individual
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Provider Name | LOIDA LIDA BRINCKHAUS FNP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2009
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 24020 PRADO LN
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City | COLTON
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State | CA
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Zip | 92324-9761
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Country | US
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Telephone | 909-954-4516
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Fax | 909-737-6698
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Provider Business Mailing Address
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Address Line | 200 OCEANGATE SUITE 100
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City | LONG BEACH
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State | CA
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Zip | 90802-4317
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Country | US
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Telephone | 562-499-6191
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Fax | 562-499-6171
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 397281
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5470
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License Number State | CA
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