Healthcare Provider Details

I. General information

NPI: 1225256548
Provider Name (Legal Business Name): WENDEL BRUNNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

50 DOUGLAS DR SUITE 391
MARTINEZ CA
94553-4098
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5110
  • Fax: 925-370-5145
Mailing address:
  • Phone: 925-957-5429
  • Fax: 925-957-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG40249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: