Healthcare Provider Details

I. General information

NPI: 1306069356
Provider Name (Legal Business Name): GARY G. BRUTON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S BEVERLY DR 100-14
BEVERLY HILLS CA
90212-4426
US

IV. Provider business mailing address

PO BOX 352040
LOS ANGELES CA
90035-0230
US

V. Phone/Fax

Practice location:
  • Phone: 310-365-8581
  • Fax:
Mailing address:
  • Phone: 310-652-9543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY16499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: