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NPI Code Detail

MEDICARE: PATRIC ROBERT BRILLHART

MEDICARE: PATRIC ROBERT BRILLHART
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YA0400XAddiction (Substance Use Disorder) CounselorB001410121CA

General Provider Information

NPI Number : 1821527771
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRIC ROBERT BRILLHART
Provider Business Mailing Address
First Line : 12070 TELEGRAPH RD
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-3771
Country : US
Telephone Number : 562-906-2676
Fax Number :
Provider Business Practice Location Address
First Line : 12070 TELEGRAPH RD
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-3771
Country : US
Telephone Number : 562-777-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2017
Last Update Date : 01/20/2021

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Directions to “ PATRIC ROBERT BRILLHART ” Practice Location

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