Provider Demographics
NPI:1134795339
Name:BRILLANTE, JOHN EDRIK MICHAEL (NP - C)
Entity type:Individual
Prefix:
First Name:JOHN EDRIK MICHAEL
Middle Name:
Last Name:BRILLANTE
Suffix:
Gender:
Credentials:NP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N BRAND BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2349
Mailing Address - Country:US
Mailing Address - Phone:818-369-6848
Mailing Address - Fax:
Practice Address - Street 1:450 N BRAND BLVD STE 600
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2349
Practice Address - Country:US
Practice Address - Phone:818-369-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily