Provider Demographics
NPI:1356451793
Name:BRINK, CORWIN HILL (MD)
Entity Type:Individual
Prefix:
First Name:CORWIN
Middle Name:HILL
Last Name:BRINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:H
Other - Last Name:BRINK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2319 SAINT ANTON DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-9162
Mailing Address - Country:US
Mailing Address - Phone:209-327-3102
Mailing Address - Fax:209-290-3258
Practice Address - Street 1:330 S FAIRMONT AVE STE 3
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3843
Practice Address - Country:US
Practice Address - Phone:209-327-3102
Practice Address - Fax:209-290-3258
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0791962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G791960Medicaid
00G791960Medicare ID - Type Unspecified
CA00G791960Medicaid