Healthcare Provider Details

I. General information

NPI: 1942138573
Provider Name (Legal Business Name): BRENDAN MACKENZIE PHARES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELDS AVE
DAVIS CA
95616-5200
US

IV. Provider business mailing address

2519 VANDERBILT LN UNIT 1
REDONDO BEACH CA
90278-3472
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-1011
  • Fax:
Mailing address:
  • Phone: 951-427-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: