MEDICARE: GREGORY BRUNET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA15590	OTHER	CA	LICENSE#

General Provider Information

NPI Number	:	1033547070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY BRUNET

Provider Business Mailing Address
First Line	:	936 CAMINO DEL RETIRO
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93110-1005
Country	:	US
Telephone Number	:	805-896-7594
Fax Number	:	805-686-9140

Provider Business Practice Location Address
First Line	:	936 CAMINO DEL RETIRO
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93110-1005
Country	:	US
Telephone Number	:	805-896-7594
Fax Number	:	805-686-9140

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. GREGORY THOMAS BRUNET I
Credential	:	PA
Telephone Number	:	805-896-7594

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	03/07/2023

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Directions to “GREGORY BRUNET ” Practice Location

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