Healthcare Provider Details

I. General information

NPI: 1568028504
Provider Name (Legal Business Name): BRENDAN JAMES COURNEENE ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 205
BEVERLY HILLS CA
90212-1840
US

IV. Provider business mailing address

18527 NAPA ST
NORTHRIDGE CA
91324-4022
US

V. Phone/Fax

Practice location:
  • Phone: 310-928-3822
  • Fax:
Mailing address:
  • Phone: 213-531-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1072
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number099.0134146
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: