Individual
BRENT P WENTWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4700 SOQUEL DR, SOQUEL, CA 95073-2427
(831) 888-9410
(831) 477-7795
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A19546
CA
Other
Enumeration date
03/18/2019
Last updated
07/25/2022
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