Basic Information
| Provider Information | |||||||||
| NPI: | 1376556944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRENNAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3370 VIENNA DR | ||||||||
| Address2: | |||||||||
| City: | APTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950032826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316884307 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10561 MERRITT ST | ||||||||
| Address2: | |||||||||
| City: | CASTROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950123310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316331514 | ||||||||
| FaxNumber: | 8316330311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G78406 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.