=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821989047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM CHRISTOPHER BRENNAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2025
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11600 ELDRIDGE AVE
-----------------------------------------------------
City | LAKE VIEW TERRACE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91342-6506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-671-9392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19665 FALCON RIDGE LN
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91326-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-336-8615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 390200000X
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------