# BRETT A GIDNEY MD A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679747448
- **Authorized official:** DR. BRETT ANDREW GIDNEY MD (PRESIDENT, CEO)
- **Authorized official phone:** (619) 287-7060

## Contact information

- **Practice address:** 5555 RESERVOIR DR, SUITE 112, SAN DIEGO, CA 92120-5134
- **Practice address phone:** (619) 287-7060
- **Mailing address:** 5555 RESERVOIR DR, SUITE 112, SAN DIEGO, CA 92120-5134
- **Mailing address phone:** (619) 287-7060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | A81336 | CA | Yes |

## Other

- **Enumeration date:** 04/14/2008
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A81336 | STATE LICENSE | CA |