Loretta Bruinsma, LPT
Individual provider Active NPI Licensed Psychiatric Technician · Azusa, CA
NPI 1255719142 · NPPES record last updated May 17, 2015
Key facts
- NPI
- 1255719142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Psychiatric Technician 167G00000X
- License
- PT25048 (CA)
- Practice address
- 23701 E East Fork Rd
Azusa, CA 91702-1477 - Phone
- (626) 250-3300
- NPI assigned
- May 11, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT25048 | CA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT25048 | CA | Yes |
Addresses
Primary practice location
23701 E East Fork Rd
Azusa, CA 91702-1477
Mailing address
23701 E East Fork Rd
Azusa, CA 91702-1477
Phone (626) 250-3300
Other providers in Azusa, CA
- Michelle Evette Brown-Black
- Aiiesha Brown
- James Willis Brown
- Latasha Mercedes Brown
- Zina Rae Brownlee
- Michelle Denise Budinko
- Emerita Bustos
- Jerrold C Bustos
- Christie Butron
- California Pediatri & Family Services, Inc
All providers in Azusa, CA · Licensed Psychiatric Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.