Organization
THE DE BRITO PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIRK DE BRITO MD, MPH (PRESIDENT)
(310) 717-0069
Entity
Organization
Contact information
Practice address
751 N FAIR OAKS AVE, 301, PASADENA, CA 91103-3069
(626) 405-4001
(818) 301-7443
Mailing address
PO BOX 247, PASADENA, CA 91102-0247
(626) 405-4001
(818) 301-7443
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
A66604
CA
302F00000X
Exclusive Provider Organization
G64523
CA
305R00000X
Preferred Provider Organization
PSY26446
CA
Other
Enumeration date
07/16/2010
Last updated
01/25/2017
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