MEDICARE: BRIAN HURLEY MD, MBA

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	2084P0802X	Addiction Psychiatry Physician	130543	CA
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	130543	CA
3	2084P0800X	Psychiatry Physician	130543	CA

General Provider Information

NPI Number	:	1770710501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN HURLEY MD, MBA

Provider Business Mailing Address
First Line	:	10940 WILSHIRE BLVD STE 710
Second Line	:	C/O CHRISTINA PUNZALAN
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7394
Country	:	US
Telephone Number	:	323-457-3675
Fax Number	:	310-382-2089

Provider Business Practice Location Address
First Line	:	10780 SANTA MONICA BLVD STE 105
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7613
Country	:	US
Telephone Number	:	310-903-9653
Fax Number	:	310-382-2089

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

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	10/01/2015

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