NPI Code Detail JSON Logo

1396093340 NPI number — BENEDETTO GIUSEPPE FORREST BRUNETTO PSY.D.

NPI Number: 1396093340
Health Care Provider/Practitioner: BENEDETTO GIUSEPPE FORREST BRUNETTO PSY.D.

Information about “1396093340” NPI (BENEDETTO GIUSEPPE FORREST BRUNETTO PSY.D.) exists in 1396093340 in HTML format HTML  |  1396093340 in plain Text format TXT  |  1396093340 in PDF (Portable Document Format) PDF  |  1396093340 in an XML format XML  formats.

NPI Number : 1396093340 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396093340",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRUNETTO",
    "FirstName": "BENEDETTO",
    "MiddleName": "GIUSEPPE FORREST",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PSY.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRUNETTO",
    "OtherFirstName": "BEN",
    "OtherMiddleName": "GIUSEPPE FORREST",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PSY.D.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1664 BROADWAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EL CAJON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92021-5201",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "619-579-8685",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "451 RIVERVIEW PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTEE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92071-5829",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-258-3089",
    "PracticeLocationAddressFaxNumber": "619-258-3203",
    "EnumerationDate": "08/23/2012",
    "LastUpdateDate": "07/12/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "PSY30812",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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