Healthcare Provider Details

I. General information

NPI: 1023250453
Provider Name (Legal Business Name): HEIDI LYNNE MILLER BRUNETTO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 E MADISON AVE
EL CAJON CA
92020-3819
US

IV. Provider business mailing address

425 N DATE ST
ESCONDIDO CA
92025-3413
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-2751
  • Fax: 858-633-4692
Mailing address:
  • Phone: 760-737-6960
  • Fax: 760-741-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number26809
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: