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General NPI Number Information
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NPI Number | 1609916063
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Entity Type | Individual
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Provider Name | BRENDT D. CARLSON MD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 846 FREEDOM BLVD
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City | WATSONVILLE
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State | CA
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Zip | 95076
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Country | US
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Telephone | 831-761-7225
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Fax | 831-761-1178
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Provider Business Mailing Address
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Address Line | 846 FREEDOM BLVD
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City | WATSONVILLE
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State | CA
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Zip | 95076
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Country | US
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Telephone | 831-761-7225
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Fax | 831-761-1178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A41986
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License Number State | CA
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