Provider Demographics
NPI:1821132218
Name:BRISLIN, MICHAEL JAY SR (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAY
Last Name:BRISLIN
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:9939 EUBANK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6502
Mailing Address - Country:US
Mailing Address - Phone:619-660-1377
Mailing Address - Fax:619-660-1377
Practice Address - Street 1:9939 EUBANK LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-6502
Practice Address - Country:US
Practice Address - Phone:619-660-1377
Practice Address - Fax:619-660-1377
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA319863163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic