Provider Demographics
NPI:1386119592
Name:INGLIS, BRIAN MICHAEL
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:INGLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 BATH AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2650
Mailing Address - Country:US
Mailing Address - Phone:619-966-8878
Mailing Address - Fax:
Practice Address - Street 1:1461 MERRITT DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-7862
Practice Address - Country:US
Practice Address - Phone:858-945-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty