Healthcare Provider Details

I. General information

NPI: 1558963967
Provider Name (Legal Business Name): BRUNO ISRAEL NEGRETE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRUNO ISRAEL NEGRETE-ZAVALA

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 4TH AVE
SAN DIEGO CA
92103-5801
US

IV. Provider business mailing address

4221 WILSHIRE BLVD STE 300A
LOS ANGELES CA
90010-3537
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3223
  • Fax: 323-866-1881
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65461
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: