Provider Demographics
NPI:1609858141
Name:BRADY, GAIL CAROLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:CAROLYN
Last Name:BRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:CAROLYN
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5046 COFLER LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2900
Mailing Address - Country:US
Mailing Address - Phone:310-601-4839
Mailing Address - Fax:818-505-3814
Practice Address - Street 1:4419 VAN NUYS BLVD
Practice Address - Street 2:STE 400
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5738
Practice Address - Country:US
Practice Address - Phone:310-601-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0164012084P0800X
CAC515882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1983772Medicaid
LA1983772Medicaid
B61270Medicare UPIN