Healthcare Provider Details

I. General information

NPI: 1538188529
Provider Name (Legal Business Name): SCOTT BRUNNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 WALKER ST SUITE 250
CYPRESS CA
90630-4733
US

IV. Provider business mailing address

11 TECHNOLOGY DR
IRVINE CA
92618-2302
US

V. Phone/Fax

Practice location:
  • Phone: 714-252-8311
  • Fax: 714-252-8339
Mailing address:
  • Phone: 949-923-3488
  • Fax: 855-812-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG57856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: