Organization
BRUSH ADVISORIES MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENRICK ANTHONY LICORISH MD (CEO)
(714) 460-2948
Entity
Organization
Contact information
Practice address
520 N MAIN ST STE 111, SANTA ANA, CA 92701
(714) 973-2378
Mailing address
PO BOX 1261, SANTA ANA, CA 92702
(714) 460-2948
Taxonomy
Speciality
Code
Description
License number
State
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
A37875
—
207R00000X
Internal Medicine Physician
Primary
A37875
—
Other
Enumeration date
10/10/2008
Last updated
10/10/2008
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