Healthcare Provider Details

I. General information

NPI: 1548860687
Provider Name (Legal Business Name): CLAUDIMAR HERNANDEZ BRENNER NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAUDIA BRENNER

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4872
US

IV. Provider business mailing address

77655 AVENIDA MONTEZUMA
LA QUINTA CA
92253-3051
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-6511
  • Fax:
Mailing address:
  • Phone: 352-246-5720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015660
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number95015660
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number95015660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: