MEDICARE: DR. GAYNE M BRENNEMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	C41223	CA

General Provider Information

NPI Number	:	1093892747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYNE M BRENNEMAN M.D.

Provider Business Mailing Address
First Line	:	29 SAN CLEMENTE DR
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-6605
Country	:	US
Telephone Number	:	310-722-2084
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 SAN CLEMENTE DR
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-6605
Country	:	US
Telephone Number	:	310-722-2084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	11/13/2024

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