Healthcare Provider Details

I. General information

NPI: 1023965514
Provider Name (Legal Business Name): BRENNA CHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CARRILLO ST
SANTA BARBARA CA
93101-1460
US

IV. Provider business mailing address

165 SAN ANGELO AVE APT 104
SANTA BARBARA CA
93111-2242
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-3307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: