Healthcare Provider Details

I. General information

NPI: 1467598318
Provider Name (Legal Business Name): DANA MARIE BRANNIGAN MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA MARIE SPERO MS, PA-C

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HUTTON CENTRE DR STE 950
SANTA ANA CA
92707-8714
US

IV. Provider business mailing address

5 HUTTON CENTRE DR STE 950
SANTA ANA CA
92707-8714
US

V. Phone/Fax

Practice location:
  • Phone: 855-434-7763
  • Fax: 949-281-5550
Mailing address:
  • Phone: 855-434-7763
  • Fax: 949-281-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA000884
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052459
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number54631
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA000884
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: