Provider Demographics
NPI:1891910501
Name:EISERMANN, BRIAN JOHN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOHN
Last Name:EISERMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 CLARK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4165
Mailing Address - Country:US
Mailing Address - Phone:530-877-3808
Mailing Address - Fax:530-877-5764
Practice Address - Street 1:6032 CLARK RD
Practice Address - Street 2:SUITE C
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4165
Practice Address - Country:US
Practice Address - Phone:530-877-3808
Practice Address - Fax:530-877-5764
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2971237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA2971OtherSTATE LICENSE