Healthcare Provider Details

I. General information

NPI: 1427083963
Provider Name (Legal Business Name): BRYAN E BRUNS MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 TOWNE CENTRE DR SUITE 370
SAN DIEGO CA
92121-3033
US

IV. Provider business mailing address

PO BOX 511278
LOS ANGELES CA
90051-7833
US

V. Phone/Fax

Practice location:
  • Phone: 858-535-0091
  • Fax:
Mailing address:
  • Phone: 866-284-2771
  • Fax: 800-334-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG29642
License Number StateCA

VIII. Authorized Official

Name: BRYAN EDWARD BRUNS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-535-0091