Healthcare Provider Details

I. General information

NPI: 1467730812
Provider Name (Legal Business Name): SARAH BRUNELLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSD DEPT OF PSYCHIATRY 9500 GILMAN DR 9116A
LA JOLLA CA
92093-0001
US

IV. Provider business mailing address

UCSD DEPT OF PSYCHIATRY 9500 GILMAN DR 9116A
LA JOLLA CA
92093-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4040
  • Fax: 858-822-0213
Mailing address:
  • Phone: 858-534-4040
  • Fax: 858-822-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA117675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: