Provider Demographics
NPI:1518024702
Name:BRIEN, EARL WARREN
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:WARREN
Last Name:BRIEN
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 1:8700 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-9887
Mailing Address - Fax:310-423-9844
Practice Address - Street 1:8700 BEVERLY BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4178
Practice Address - Country:US
Practice Address - Phone:310-423-9887
Practice Address - Fax:310-423-9844
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61297207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3603726Medicaid
CA050256Medicare ID - Type Unspecified
CA3603726Medicaid