Provider Demographics
NPI:1194731604
Name:BROTHERTON, JOY (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CARSON ST
Mailing Address - Street 2:BOX 3
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-2509
Mailing Address - Fax:310-222-8822
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:BOX 3
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2509
Practice Address - Fax:310-222-8822
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96040207V00000X
CAA86768207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56398OtherBCBS
CAA86768OtherCALIFORNIA LICENSE
FL277040700Medicaid
CADA6447OtherRAILROAD MEDICARE
CAM050376OtherCOUNTY OF LOS ANGELES-HARBOR UCLA MEDICAL CENTER
CADA6447OtherRAILROAD MEDICARE
CAAR650ZMedicare PIN
I64196Medicare UPIN