Healthcare Provider Details

I. General information

NPI: 1245397868
Provider Name (Legal Business Name): BRONNER HANDWERGER N.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DRIVE SUITE A107
LA JOLLA CA
92037
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DRIVE SUITE A107
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 858-254-5433
  • Fax: 866-463-9349
Mailing address:
  • Phone: 858-254-5433
  • Fax: 866-463-9349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-81
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: