Provider Demographics
NPI:1992185193
Name:BRIL, IGOR (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:BRIL
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1520
Mailing Address - Country:US
Mailing Address - Phone:650-503-6362
Mailing Address - Fax:
Practice Address - Street 1:2943 BROADWAY
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1520
Practice Address - Country:US
Practice Address - Phone:650-503-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15974171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist