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NPI Code Detail

MEDICARE: MR. GUILLERMO LEON BRZOSTOWSKI MFT

MEDICARE: MR. GUILLERMO LEON BRZOSTOWSKI MFT
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
1106H00000XMarriage & Family Therapist44750CA

General Provider Information

NPI Number : 1568589562
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GUILLERMO LEON BRZOSTOWSKI MFT
Provider Business Mailing Address
First Line : 351 MUSEUM DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90065-5051
Country : US
Telephone Number : 323-342-9866
Fax Number : 323-342-9866
Provider Business Practice Location Address
First Line : 2904 ROWENA AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-2042
Country : US
Telephone Number : 323-828-9866
Fax Number : 323-342-9866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 02/15/2008

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