Brennon King, ATC, CES
Individual provider Active NPI Athletic Trainer · Orcutt, CA
NPI 1427464288 · NPPES record last updated Jul 1, 2014
Key facts
- NPI
- 1427464288
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 2000013678 (CA)
- Practice address
- 610 Pinal Ave
Orcutt, CA 93455-5302 - Phone
- (425) 248-0315
- NPI assigned
- Jul 1, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000013678 | CA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000013678 | CA | Yes |
Addresses
Primary practice location
610 Pinal Ave
Orcutt, CA 93455-5302
Mailing address
339 Jaycee Dr
San Luis Obispo, CA 93405-1243
Phone (425) 248-0315
Other providers in Orcutt, CA
- Gretchen Amigo Jo
- Christina Johnson
- Kristen Layne Johnson
- Sandra L. Jordan
- KD Medical Inc
- Mindy Lam
- Lights on Learning
- Michelle Mackinnon
- Milan McGary
- Debra Meeks
All providers in Orcutt, CA · Athletic Trainer in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.