Healthcare Provider Details

I. General information

NPI: 1437184975
Provider Name (Legal Business Name): BRYAN EDWARD BRUNS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1759 BERYL ST
SAN DIEGO CA
92109-2214
US

IV. Provider business mailing address

1759 BERYL ST
SAN DIEGO CA
92109-2214
US

V. Phone/Fax

Practice location:
  • Phone: 858-535-0091
  • Fax: 858-535-0080
Mailing address:
  • Phone: 858-442-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG-29642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: