Healthcare Provider Details

I. General information

NPI: 1255309555
Provider Name (Legal Business Name): JAMES ANDREW BRUNBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 3100
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y STREET SUITE 3100
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7223
  • Fax:
Mailing address:
  • Phone: 916-734-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberC035147
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberC035147
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC035147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: