# BRIAN D. BRANTNER, M.D. A PROFESSIONAL CORPORATION

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

## Provider details

- **NPI number:** 1780861443
- **Authorized official:** DR. BRIAN D. BRANTNER M.D. (PRESIDENT)
- **Authorized official phone:** (805) 653-6765

## Contact information

- **Practice address:** 3555 LOMA VISTA RD, SUITE 200, VENTURA, CA 93003-3161
- **Practice address phone:** (805) 653-6765
- **Practice address fax:** (805) 653-1470
- **Mailing address:** 3555 LOMA VISTA RD, SUITE 200, VENTURA, CA 93003-3161
- **Mailing address phone:** (805) 653-6765
- **Mailing address fax:** (805) 653-1470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G027037 | CA | Yes |

## Other

- **Enumeration date:** 01/24/2008
- **Last updated:** 07/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | G02-7037 | MEDICARE ID- TYPE UNSPECIFIRED | CA |