Basic Information
| Provider Information | |||||||||
| NPI: | 1760687560 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DALE J BRENT MD A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4955 VAN NUYS BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187841195 | ||||||||
| FaxNumber: | 8187846473 | ||||||||
| Practice Location | |||||||||
| Address1: | 4955 VAN NUYS BLVD | ||||||||
| Address2: | SUITE 411 | ||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187841195 | ||||||||
| FaxNumber: | 8187847026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRENT | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8187841195 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A43070 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.