Healthcare Provider Details

I. General information

NPI: 1437216926
Provider Name (Legal Business Name): PEDIATRIC & ADULT MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13132 NEWPORT AVE STE 100
TUSTIN CA
92780-3429
US

IV. Provider business mailing address

13132 NEWPORT AVE STE 100
TUSTIN CA
92780-3429
US

V. Phone/Fax

Practice location:
  • Phone: 714-565-7960
  • Fax: 714-565-7982
Mailing address:
  • Phone: 714-565-7960
  • Fax: 714-565-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN LYNN BRUNER
Title or Position: PRESIDENT
Credential: MD
Phone: 714-565-7960