Individual
JEFFREY R BRENEISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1860 PENNSYLVANIA AVE, SUITE 120, FAIRFIELD, CA 94533-3590
(707) 646-4400
(707) 646-4401
Mailing address
1860 PENNSYLVANIA AVE, SUITE 120, FAIRFIELD, CA 94533-3590
(707) 646-4400
(707) 646-4401
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G86677
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G866770
—
CA
Enumeration date
01/18/2006
Last updated
07/31/2015
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