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General NPI Number Information
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NPI Number | 1831489699
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Entity Type | Individual
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Provider Name | CAROLYN BRILEY
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Gender | Female
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 251 LANDIS AVE STE 201
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City | CHULA VISTA
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State | CA
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Zip | 91910-2629
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Country | US
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Telephone | 619-498-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 3760 CONVOY ST STE 204
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City | SAN DIEGO
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State | CA
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Zip | 92111-3744
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6452
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License Number State | CA
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