Healthcare Provider Details

I. General information

NPI: 1720993876
Provider Name (Legal Business Name): MARIA GUADALUPE BRUNER LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72700 DINAH SHORE DR STE 200
PALM DESERT CA
92211-0859
US

IV. Provider business mailing address

72700 DINAH SHORE DR STE 200
PALM DESERT CA
92211-0859
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 760-861-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number210851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: