Provider Demographics
NPI:1790958015
Name:COLLINS, BRYNIE S (MD)
Entity Type:Individual
Prefix:
First Name:BRYNIE
Middle Name:S
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:818-905-6628
Mailing Address - Fax:818-905-6610
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:818-905-6628
Practice Address - Fax:818-905-6610
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA806002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology