Provider Demographics
NPI:1962534958
Name:HUTTON, BRENDA ROXANA
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ROXANA
Last Name:HUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 FIRESTONE BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4328
Mailing Address - Country:US
Mailing Address - Phone:562-864-3722
Mailing Address - Fax:562-864-4596
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:562-864-3722
Practice Address - Fax:562-864-4596
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner