Provider Demographics
NPI:1770591372
Name:RILEY, BRENDAN MARLOW (DPM)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:MARLOW
Last Name:RILEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24066 AVOCADO LANE
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354
Mailing Address - Country:US
Mailing Address - Phone:661-255-1521
Mailing Address - Fax:
Practice Address - Street 1:100 UCLA MEDICAL PLAZA
Practice Address - Street 2:STE #460
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-443-8999
Practice Address - Fax:310-208-4847
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4496213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V05566Medicare UPIN