Healthcare Provider Details

I. General information

NPI: 1982794855
Provider Name (Legal Business Name): ELIZABETH BRENNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 COMMERCIAL CROSSING
SANTA CRUZ CA
95065-1702
US

IV. Provider business mailing address

2025 SOQUEL AVE
SANTA CRUZ CA
95062-1323
US

V. Phone/Fax

Practice location:
  • Phone: 831-458-5511
  • Fax: 831-458-5570
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG79874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: