Provider Demographics
NPI:1881864502
Name:GAIL C. BRADY MD, A PROFESSIONAL
Entity Type:Organization
Organization Name:GAIL C. BRADY MD, A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-601-4839
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:985-789-7920
Mailing Address - Fax:818-505-3814
Practice Address - Street 1:300 S BEVERLY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4808
Practice Address - Country:US
Practice Address - Phone:310-601-4839
Practice Address - Fax:818-505-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL0164012084P0800X
CAC515882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1983772Medicaid
LA1983772Medicaid
5L338Medicare PIN