Provider Demographics
NPI:1689301236
Name:BRINK, ISABELLA (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:BRINK
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2306
Mailing Address - Country:US
Mailing Address - Phone:541-490-6908
Mailing Address - Fax:
Practice Address - Street 1:701 GATEWAY BLVD STE 380
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7420
Practice Address - Country:US
Practice Address - Phone:877-688-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001409170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS