Provider Demographics
NPI:1831199017
Name:BRETT, JOEY (MD)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:BRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 VENTURA BLVD
Mailing Address - Street 2:# 738
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3606
Mailing Address - Country:US
Mailing Address - Phone:818-789-0034
Mailing Address - Fax:818-789-0042
Practice Address - Street 1:13320 RIVERSIDE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2502
Practice Address - Country:US
Practice Address - Phone:818-789-0034
Practice Address - Fax:818-789-0042
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A551020OtherMEDI-CAL RENDERING NUMBER
CAWA55102COtherMEDICARE PPIN
CAWA55102COtherMEDICARE PPIN