Healthcare Provider Details

I. General information

NPI: 1316724859
Provider Name (Legal Business Name): RHETT BRUCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S WINCHESTER BLVD STE 101
CAMPBELL CA
95008-1163
US

IV. Provider business mailing address

1700 S WINCHESTER BLVD STE 101
CAMPBELL CA
95008-1163
US

V. Phone/Fax

Practice location:
  • Phone: 408-824-9355
  • Fax:
Mailing address:
  • Phone: 408-824-9355
  • Fax: 805-468-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: