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NPI Code Detail

MEDICARE: PATRICIA BRENN

MEDICARE: PATRICIA BRENN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistG1104CA
2174400000XSpecialistG41108CA
3207NS0135XProcedural Dermatology PhysicianG41108CA

General Provider Information

NPI Number : 1609281328
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA BRENN
Provider Business Mailing Address
First Line : 17851 ARBOR LN
Second Line :
City : IRVINE
State : CA
Zip : 92612-2801
Country : US
Telephone Number : 714-328-0698
Fax Number : 949-786-5049
Provider Business Practice Location Address
First Line : 17851 ARBOR LN
Second Line :
City : IRVINE
State : CA
Zip : 92612-2801
Country : US
Telephone Number : 714-238-0698
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2014
Last Update Date : 06/23/2014

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Directions to “ PATRICIA BRENN ” Practice Location

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