Healthcare Provider Details

I. General information

NPI: 1376997916
Provider Name (Legal Business Name): JULIA BRUCKNER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD STE 326
ENCINO CA
91316-5214
US

IV. Provider business mailing address

5400 BALBOA BLVD STE 326
ENCINO CA
91316-5214
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-0492
  • Fax: 818-789-6726
Mailing address:
  • Phone: 818-789-0492
  • Fax: 818-789-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A16457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: