Healthcare Provider Details

I. General information

NPI: 1629697800
Provider Name (Legal Business Name): BRENT PATRICK TWIFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

3534 5TH AVE APT 422
SAN DIEGO CA
92103-5069
US

V. Phone/Fax

Practice location:
  • Phone: 559-901-8659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A23904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: