Healthcare Provider Details

I. General information

NPI: 1629187448
Provider Name (Legal Business Name): FREDERIC WALTER BRUHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 E HUNTINGTON AVE
FRESNO CA
93702-2962
US

IV. Provider business mailing address

765 CALLE LOS OLIVOS
SAN CLEMENTE CA
92673-2717
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4300
  • Fax: 559-459-4569
Mailing address:
  • Phone: 559-760-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG43549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: