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General NPI Number Information
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NPI Number | 1780453191
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Entity Type | Individual
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Provider Name | BRETT BIRD NP
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Gender | Male
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 12740 HESPERIA RD STE B
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City | VICTORVILLE
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State | CA
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Zip | 92395-8306
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Country | US
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Telephone | 760-998-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 21360 TELEGRAPH RD
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City | RIVERSIDE
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State | CA
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Zip | 92507-0053
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Country | US
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Telephone | 949-292-0334
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 95028522
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License Number State | CA
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