Provider Demographics
NPI:1376534792
Name:HINRICHSEN, BRIAN CURTIS (PA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CURTIS
Last Name:HINRICHSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ASHBY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2067
Mailing Address - Country:US
Mailing Address - Phone:510-204-2500
Mailing Address - Fax:
Practice Address - Street 1:3010 COLBY ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2091
Practice Address - Country:US
Practice Address - Phone:510-204-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15623207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA156230Medicaid
CAOPA156230Medicare ID - Type Unspecified
CA0PA156234Medicare PIN
CAOPA156230Medicaid