MEDICARE: PHILIP P BRODAK MD

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
1	208800000X	Urology Physician	G64287	CA

General Provider Information

NPI Number	:	1417057514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP P BRODAK MD

Provider Business Mailing Address
First Line	:	25495 MEDICAL CENTER DR
Second Line	:	SUITE 204
City	:	MURRIETA
State	:	CA
Zip	:	92562-4902
Country	:	US
Telephone Number	:	951-698-1901
Fax Number	:	951-698-1074

Provider Business Practice Location Address
First Line	:	25495 MEDICAL CENTER DR STE 204
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-4903
Country	:	US
Telephone Number	:	951-698-1901
Fax Number	:	951-364-3639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	09/09/2024

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Directions to “ PHILIP P BRODAK MD” Practice Location

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