Healthcare Provider Details

I. General information

NPI: 1396093340
Provider Name (Legal Business Name): BENEDETTO GIUSEPPE FORREST BRUNETTO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEN GIUSEPPE FORREST BRUNETTO PSY.D.

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 RIVERVIEW PKWY
SANTEE CA
92071-5829
US

IV. Provider business mailing address

1664 BROADWAY
EL CAJON CA
92021-5201
US

V. Phone/Fax

Practice location:
  • Phone: 619-258-3089
  • Fax: 619-258-3203
Mailing address:
  • Phone: 619-579-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: