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General NPI Number Information
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NPI Number | 1861545576
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Entity Type | Organization
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Legal Business Name | MARK A. BRIM, D.P.M., INC.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 17200 VENTURA BLVD. SUITE 207
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City | ENCINO
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State | CA
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Zip | 91316-2804
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Country | US
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Telephone | 818-783-3338
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Fax | 818-583-1444
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Provider Business Mailing Address
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Address Line | 17200 VENTURA BLVD SUITE 207
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City | ENCINO
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State | CA
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Zip | 91316-4005
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Country | US
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Telephone | 818-783-3338
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Fax | 818-583-1444
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A. BRIM
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Credential | D.P.M.
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Telephone | 818-783-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E1542
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License Number State | CA
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