Provider Demographics
NPI:1093892747
Name:BRENNEMAN, GAYNE M (MD)
Entity type:Individual
Prefix:DR
First Name:GAYNE
Middle Name:M
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SAN CLEMENTE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6605
Mailing Address - Country:US
Mailing Address - Phone:310-722-2084
Mailing Address - Fax:
Practice Address - Street 1:29 SAN CLEMENTE DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6605
Practice Address - Country:US
Practice Address - Phone:310-722-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41223207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology