Basic Information
Provider Information
NPI: 1417009176
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRIZENDINE
FirstName: LOUANN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1635 DIVISADERO ST STE 625 BOX 1821
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941430001
CountryCode: US
TelephoneNumber: 4154764029
FaxNumber: 4154764150
Practice Location
Address1: 401 PARNASSUS AVE
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941432211
CountryCode: US
TelephoneNumber: 4154767840
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/16/2007
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XG61841CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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