Individual
M. DOUGLAS BRANNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8700 BEVERLY BLVD # SB-290, WEST HOLLYWOOD, CA 90048-1804
(310) 423-1447
(310) 423-0387
Mailing address
4140 W 190TH ST, TORRANCE, CA 90504-5513
(310) 231-4474
(310) 423-0387
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
AP30005884
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
76225
CA
367500000X
Certified Registered Nurse Anesthetist
AP30005884
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0217761
L&I PIN
WA
01
—
64963U
REGENCE BLUE SHIELD PIN
WA
05
—
9632712
—
WA
05
—
9653106
—
WA
Enumeration date
01/22/2007
Last updated
10/30/2020
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