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NPI Code Detail

MEDICARE: DR. HERNAN R BRIZUELA M.D.

MEDICARE: DR. HERNAN R BRIZUELA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VH0002XHospice and Palliative Medicine (Obstetrics & Gynecology) PhysicianMD037850LPA
2207QA0505XAdult Medicine PhysicianMD037850LPA

General Provider Information

NPI Number : 1174744064
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HERNAN R BRIZUELA M.D.
Provider Business Mailing Address
First Line : 34 LATHAM PARK
Second Line :
City : ELKINS PARK
State : PA
Zip : 19027
Country : US
Telephone Number : 215-635-8929
Fax Number : 215-635-4151
Provider Business Practice Location Address
First Line : 8019 FRANKFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19136-2786
Country : US
Telephone Number : 215-694-0469
Fax Number : 215-635-4151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 06/07/2015

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