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General NPI Number Information
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NPI Number | 1740381995
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Entity Type | Organization
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Legal Business Name | ROBERT A BRENNER
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 8860 CENTER DRIVE SUITE 420
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City | LA MESA
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State | CA
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Zip | 91942-7001
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Country | US
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Telephone | 619-469-5400
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Fax | 619-464-1311
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Provider Business Mailing Address
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Address Line | 8860 CENTER DRIVE SUITE 420
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City | LA MESA
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State | CA
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Zip | 91942-7001
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Country | US
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Telephone | 619-469-5400
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Fax | 619-464-1311
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT A BRENNER
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Credential | M.D.
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Telephone | 619-469-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G51139
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License Number State | CA
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