Healthcare Provider Details

I. General information

NPI: 1346650629
Provider Name (Legal Business Name): ANGELA BRENNAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

55 CITRON KNL
ORINDA CA
94563-2532
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4123
  • Fax:
Mailing address:
  • Phone: 831-796-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: