MEDICARE: DR. BRUCE HARRIS VAN VRANKEN M.D.

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	207Q00000X	Family Medicine Physician	G32570	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093742173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE HARRIS VAN VRANKEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	24331 EL TORO RD STE 330
Second Line	:
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-2754
Country	:	US
Telephone Number	:	949-716-0833
Fax Number	:	949-716-0830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	11/30/2025

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