Healthcare Provider Details

I. General information

NPI: 1457377202
Provider Name (Legal Business Name): BRET CHRISTOPHER POWERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 MAGNOLIA AVE SUITE 106
CORONA CA
92879-3104
US

IV. Provider business mailing address

PO BOX 1007
MURRIETA CA
92564-1007
US

V. Phone/Fax

Practice location:
  • Phone: 951-270-0882
  • Fax: 951-270-0888
Mailing address:
  • Phone: 951-696-9061
  • Fax: 951-696-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number20A9577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: