Provider Demographics
NPI:1114054186
Name:BRINES, LEAH D
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:D
Last Name:BRINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE PEDIATRICS
Mailing Address - Street 2:1375 EAST 20TH AVE
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205
Mailing Address - Country:US
Mailing Address - Phone:303-360-1233
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE PEDIATRICS
Practice Address - Street 2:1375 EAST 20TH AVE
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:303-360-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102579208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
008315OtherKAISER-COMMERCIAL NUMBER