Healthcare Provider Details

I. General information

NPI: 1437641230
Provider Name (Legal Business Name): JAMES A BRUCKNER SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 GREEN VISTA DR
ENCINO CA
91436-4014
US

IV. Provider business mailing address

3540 GREEN VISTA DR
ENCINO CA
91436-4014
US

V. Phone/Fax

Practice location:
  • Phone: 661-312-3112
  • Fax:
Mailing address:
  • Phone: 661-312-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: