| Doctor Name: | BRIAN PETERNELL |
| NPI Number: | 1871853796 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 20A13464 |
| Business Practice Address: | 584 35th Ave Santa Cruz, CA - 950625111 |
| Business Phone Number: | 8312912455 |
| Business Fax Number: | |
| Mailing Address: | 584 35th Ave, SANTA CRUZ |
| State: | CA |
| Postal Code: | 950625111 |
| Phone Number: | 8312912455 |
| Fax Number: | |
| NPI Enumeration Date: | 05/24/2012 |
| NPI Last Update Date: | 07/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 20A13464 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |