1821147570 NPI number — MS. MARYBETH BRENNING MA COMMUNICATIVE DIS

Table of content: MS. MARYBETH BRENNING MA COMMUNICATIVE DIS (NPI 1821147570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821147570 NPI number — MS. MARYBETH BRENNING MA COMMUNICATIVE DIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNING
Provider First Name:
MARYBETH
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA COMMUNICATIVE DIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRENNING
Provider Other First Name:
MARY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821147570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
383 JUNIPER AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFIC GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-241-0297
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 GARDEN ST.
Provider Second Line Business Practice Location Address:
STE CHOICE HOME HEALTH CARE
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-645-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP5366 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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