Healthcare Provider Details

I. General information

NPI: 1063016319
Provider Name (Legal Business Name): BRONWYN PURCELL-DEABREU DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 IMHOFF PL
MARTINEZ CA
94553-4300
US

IV. Provider business mailing address

1701 SHORELINE DR APT 106
ALAMEDA CA
94501-6001
US

V. Phone/Fax

Practice location:
  • Phone: 925-608-8428
  • Fax:
Mailing address:
  • Phone: 201-927-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number22511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: