Healthcare Provider Details

I. General information

NPI: 1609418581
Provider Name (Legal Business Name): MATTHEW WILLIAM BRESNAHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 COYLE AVE
CARMICHAEL CA
95608-0438
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-535-2000
  • Fax: 916-408-8000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: