Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD037850L | PA |
NPI | 1174744064 |
---|---|
Provider Name | Dr. Hernan R Brizuela |
First Address | Elkins Park, PA 19027 |
Second Address | Philadelphia, PA 19136-2786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 07/06/2015 |