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General NPI Number Information
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NPI Number | 1922024926
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Entity Type | Individual
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Provider Name | BRIAN KNUDSEN CONNOLLY PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 8151 ARLINGTON AVE SUITES U-V
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City | RIVERSIDE
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State | CA
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Zip | 92503-0436
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Country | US
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Telephone | 760-728-3816
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Fax | 760-728-1542
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Provider Business Mailing Address
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Address Line | 8151 ARLINGTON AVE SUITES U-V
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City | RIVERSIDE
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State | CA
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Zip | 92503-0436
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Country | US
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Telephone | 760-728-3816
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Fax | 760-728-1542
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 15157
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License Number State | CA
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