Healthcare Provider Details

I. General information

NPI: 1093404634
Provider Name (Legal Business Name): PATRICIA ANN BRUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9713
US

IV. Provider business mailing address

3116 STAGECOACH CT
VALLEY SPRINGS CA
95252-9235
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-6536
  • Fax:
Mailing address:
  • Phone: 209-304-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number457401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: