Healthcare Provider Details

I. General information

NPI: 1679612907
Provider Name (Legal Business Name): TODD V BRENNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 BEVERLY BLVD FL 2
WEST HOLLYWOOD CA
90048
US

IV. Provider business mailing address

8900 BEVERLY BLVD FL 2
WEST HOLLYWOOD CA
90048-2438
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-7408
  • Fax: 310-423-0234
Mailing address:
  • Phone: 310-423-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number2009-01670
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA75140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: