MEDICARE: RYANN BRENNER

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1558764084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYANN BRENNER

Provider Business Mailing Address
First Line	:	12610 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12610 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5252
Country	:	US
Telephone Number	:	323-757-1853
Fax Number	:

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	03/10/2022

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Directions to “ RYANN BRENNER ” Practice Location

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