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General NPI Number Information
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NPI Number | 1659136026
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Entity Type | Individual
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Provider Name | ROBERT BRINKLEY
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Gender | Male
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 11646 ENCANTO LN
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City | COLTON
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State | CA
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Zip | 92324-9218
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Country | US
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Telephone | 909-296-5007
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Fax |
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Provider Business Mailing Address
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Address Line | 1804B MAIN ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-1830
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Country | US
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Telephone | 951-490-3266
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | R1544990124
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | R1544990124
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License Number State | CA
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