Healthcare Provider Details

I. General information

NPI: 1194998708
Provider Name (Legal Business Name): BARRY WILLIAM BREUNINGER IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4256 STEWART MESA RD
OCEANSIDE CA
92055
US

IV. Provider business mailing address

BOX 555341 1ST MSOB
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-6577
  • Fax:
Mailing address:
  • Phone: 760-725-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP08030093BB
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: