Individual
MR. BRIAN SCOTT PENDLEBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
1722 S LEWIS RD, CAMARILLO, CA 93012-8520
(805) 445-7800
(805) 445-7830
Mailing address
307 CHARRO AVE, THOUSAND OAKS, CA 91320-3658
(805) 630-3101
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT24244
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT24244
LICENSE
CA
Enumeration date
03/15/2007
Last updated
07/08/2007
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