Provider Demographics
NPI:1427160886
Name:BRITO, CARMEN EDITH (NP)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:EDITH
Last Name:BRITO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9470 GIVENS PL
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2508
Mailing Address - Country:US
Mailing Address - Phone:818-701-7274
Mailing Address - Fax:
Practice Address - Street 1:3400 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5835
Practice Address - Country:US
Practice Address - Phone:323-589-9384
Practice Address - Fax:323-589-0358
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP6316Medicaid
CAWPA13149BMedicare UPIN