Healthcare Provider Details

I. General information

NPI: 1871497172
Provider Name (Legal Business Name): MS. JENNIFER BRUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 MEDICAL CENTER RD
MISSION VIEJO CA
92691-6426
US

IV. Provider business mailing address

2158 OLIVER AVE
SAN DIEGO CA
92109-5549
US

V. Phone/Fax

Practice location:
  • Phone: 909-838-1577
  • Fax:
Mailing address:
  • Phone: 909-838-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2000744708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: