Healthcare Provider Details

I. General information

NPI: 1255361432
Provider Name (Legal Business Name): H. GEORGE BRENNAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWPORT CENTER DR STE. 100
NEWPORT BEACH CA
92660-7601
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD STE. 440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 949-644-1641
  • Fax:
Mailing address:
  • Phone: 310-440-3131
  • Fax: 310-472-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberC27484
License Number StateCA

VIII. Authorized Official

Name: DR. H. GEORGE BRENNAN
Title or Position: OWNER
Credential: M.D.
Phone: 949-644-1641