Provider Demographics
NPI:1275227902
Name:HUMESTON, BRENT M
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:M
Last Name:HUMESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 SAWTELLE BLVD APT 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1446
Mailing Address - Country:US
Mailing Address - Phone:209-499-1179
Mailing Address - Fax:
Practice Address - Street 1:3150 SAWTELLE BLVD APT 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1446
Practice Address - Country:US
Practice Address - Phone:209-499-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program