Healthcare Provider Details

I. General information

NPI: 1104355767
Provider Name (Legal Business Name): HANNAH BRUNET PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E TEMPLE ST
LOS ANGELES CA
90012-3328
US

IV. Provider business mailing address

351 E TEMPLE ST BUILDING 1 ROOM A438
LOS ANGELES CA
90012-4282
US

V. Phone/Fax

Practice location:
  • Phone: 408-607-2009
  • Fax:
Mailing address:
  • Phone: 408-607-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: