Healthcare Provider Details

I. General information

NPI: 1528132487
Provider Name (Legal Business Name): J BRENNAN CASSIDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 S BRISTOL ST SUITE 202
SANTA ANA CA
92704-7427
US

IV. Provider business mailing address

3929 S BRISTOL ST SUITE 202
SANTA ANA CA
92704-7427
US

V. Phone/Fax

Practice location:
  • Phone: 714-662-0322
  • Fax: 714-662-0329
Mailing address:
  • Phone: 714-662-0322
  • Fax: 714-662-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberC30247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: