Provider Demographics
NPI:1497049290
Name:BRYNIE SLOME COLLINS MD, INC
Entity Type:Organization
Organization Name:BRYNIE SLOME COLLINS MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-905-6600
Mailing Address - Street 1:5363 BALBOA BLVD.
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2805
Mailing Address - Country:US
Mailing Address - Phone:818-905-6600
Mailing Address - Fax:
Practice Address - Street 1:5363 BALBOA BLVD.
Practice Address - Street 2:SUITE 540
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2805
Practice Address - Country:US
Practice Address - Phone:818-905-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA806002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty