Healthcare Provider Details

I. General information

NPI: 1730272527
Provider Name (Legal Business Name): BARBARA BRUTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4267 MARINA CITY DR UNIT 1106
MARINA DEL REY CA
90292-5812
US

IV. Provider business mailing address

18815 PEPPERDINE DR
CARSON CA
90746-3905
US

V. Phone/Fax

Practice location:
  • Phone: 424-384-3432
  • Fax: 310-817-2012
Mailing address:
  • Phone: 310-817-2012
  • Fax: 310-715-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA45856
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA45856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: