Provider Demographics
NPI:1427031913
Name:BRENDER, ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:
Last Name:BRENDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 ALBANY CIR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-6333
Mailing Address - Country:US
Mailing Address - Phone:714-744-9442
Mailing Address - Fax:714-744-1633
Practice Address - Street 1:10661 ALBANY CIR
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861-6333
Practice Address - Country:US
Practice Address - Phone:714-744-9442
Practice Address - Fax:714-744-1633
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23902208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG23902Medicare ID - Type UnspecifiedMD LICENSE