Provider Demographics
NPI:1043421761
Name:GERALD BRESNAHAN, M.D., INC.
Entity Type:Organization
Organization Name:GERALD BRESNAHAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BRESNAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-672-3636
Mailing Address - Street 1:575 E HARDY ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4036
Mailing Address - Country:US
Mailing Address - Phone:310-672-3636
Mailing Address - Fax:310-672-1021
Practice Address - Street 1:575 E HARDY ST
Practice Address - Street 2:SUITE 305
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4036
Practice Address - Country:US
Practice Address - Phone:310-672-3636
Practice Address - Fax:310-672-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14924207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA061916025OtherRAILROAD MEDICARE
CA00G149240Medicaid
CA061916025OtherRAILROAD MEDICARE