Provider Demographics
NPI:1891855466
Name:BRESNAHAN, GERALD FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:FRANCIS
Last Name:BRESNAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E HARDY ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4036
Mailing Address - Country:US
Mailing Address - Phone:310-672-3636
Mailing Address - Fax:310-672-1021
Practice Address - Street 1:575 E HARDY ST
Practice Address - Street 2:SUITE 305
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4036
Practice Address - Country:US
Practice Address - Phone:310-672-3636
Practice Address - Fax:310-672-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14924207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA061916025OtherRAILROAD MEDICARE
CA00G149240Medicaid
CAWG14924GMedicare PIN
A39383Medicare UPIN
CA00G149240Medicaid