Organization
THE DE BRITO PROFESSIONAL MEDICAL CORPORATION
Active
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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