Basic Information
| Provider Information | |||||||||
| NPI: | 1487093951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRERETON | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | STUART | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4445 EASTGATE MALL | ||||||||
| Address2: | STE 105 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921211979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584126080 | ||||||||
| FaxNumber: | 8584126376 | ||||||||
| Practice Location | |||||||||
| Address1: | 26520 CACTUS AVE | ||||||||
| Address2: | RCRMC ORTHOPAEDIC SURGERY CLINIC | ||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514864552 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | R7395 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 20A13592 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.