Provider Demographics
NPI:1154650869
Name:MARIA BRICKMAN, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MARIA BRICKMAN, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-782-0160
Mailing Address - Street 1:721 N KILKEA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7005
Mailing Address - Country:US
Mailing Address - Phone:323-782-0160
Mailing Address - Fax:
Practice Address - Street 1:9229 W SUNSET BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3402
Practice Address - Country:US
Practice Address - Phone:323-658-7655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA731532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT251AMedicare PIN