Healthcare Provider Details

I. General information

NPI: 1336179027
Provider Name (Legal Business Name): WARNER P BUNDENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

15822 LIME GROVE RD
POWAY CA
92064-2112
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8630
  • Fax: 619-543-3183
Mailing address:
  • Phone: 858-679-7320
  • Fax: 858-679-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG28654
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG28654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: