Provider Demographics
NPI:1568028504
Name:COURNEENE, BRENDAN JAMES (ND)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:JAMES
Last Name:COURNEENE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18527 NAPA ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4022
Mailing Address - Country:US
Mailing Address - Phone:213-531-2210
Mailing Address - Fax:
Practice Address - Street 1:120 S SPALDING DR STE 205
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1840
Practice Address - Country:US
Practice Address - Phone:310-928-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1072175F00000X
VT099.0134146202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMC5629968OtherDEA