Healthcare Provider Details

I. General information

NPI: 1992636807
Provider Name (Legal Business Name): CATHY BRUN RN BSN PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35912 AVENUE H
YUCAIPA CA
92399-5206
US

IV. Provider business mailing address

35912 AVENUE H
YUCAIPA CA
92399-5206
US

V. Phone/Fax

Practice location:
  • Phone: 909-790-8550
  • Fax: 909-790-8541
Mailing address:
  • Phone: 909-790-8550
  • Fax: 909-790-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number424751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: