Provider Demographics
NPI:1952754822
Name:BRENNER, TINA (MHS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 S LAKE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3617
Mailing Address - Country:US
Mailing Address - Phone:646-650-5337
Mailing Address - Fax:646-871-6820
Practice Address - Street 1:475 S LAKE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3617
Practice Address - Country:US
Practice Address - Phone:646-650-5337
Practice Address - Fax:646-871-6820
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant