Healthcare Provider Details

I. General information

NPI: 1154636769
Provider Name (Legal Business Name): LOUIS G. BRENNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LEICESTER CT
LAGUNA NIGUEL CA
92677-9380
US

IV. Provider business mailing address

4 LEICESTER COURT
LAGUNA NIGUEL CA
92677
US

V. Phone/Fax

Practice location:
  • Phone: 949-481-0285
  • Fax:
Mailing address:
  • Phone: 949-481-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberCFE25219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: