=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881864502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAIL C. BRADY MD, A PROFESSIONAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2008
-----------------------------------------------------
Last Update Date | 07/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S BEVERLY DR SUITE 205
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212-4808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-601-4839
-----------------------------------------------------
Fax | 818-505-3814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 638 LINDERO CANYON RD STE 326
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91377-5457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-601-4839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DR. GAIL C BRADY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-601-4839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | L016401
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | C51588
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------