Provider Demographics
NPI:1538728811
Name:GALLENT, BRAD (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:GALLENT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:WALLENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8700 BEVERLY BLVD STE 5512
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-2811
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD STE 5512
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program