Basic Information
| Provider Information | |||||||||
| NPI: | 1013967215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRINK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JACOBUS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3067 | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959923067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307514784 | ||||||||
| FaxNumber: | 5307514906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 PLUMAS ST | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959913455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308212020 | ||||||||
| FaxNumber: | 5308212038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A53326 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A533260 | 05 | CA | MEDICAID |