Provider Demographics
NPI:1609281328
Name:BRENN, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BRENN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:BRENN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17851 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2801
Mailing Address - Country:US
Mailing Address - Phone:714-328-0698
Mailing Address - Fax:949-786-5049
Practice Address - Street 1:17851 ARBOR LN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2801
Practice Address - Country:US
Practice Address - Phone:714-238-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG1104174400000X
CAG41108174400000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No174400000XOther Service ProvidersSpecialist