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General NPI Number Information
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NPI Number | 1306112362
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Entity Type | Organization
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Legal Business Name | JAMES E BRUNS OD A PROFESSIONAL
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 6180 STATE FARM DR
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2135
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Country | US
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Telephone | 707-584-7294
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Fax | 707-584-4728
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Provider Business Mailing Address
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Address Line | 6180 STATE FARM DR
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2135
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Country | US
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Telephone | 707-584-7294
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Fax | 707-584-4728
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LESLIE C BORDI
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Credential |
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Telephone | 707-584-7294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | CA5247
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License Number State | CA
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