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General NPI Number Information
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NPI Number | 1528069820
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Entity Type | Individual
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Provider Name | BRENTON D WYNN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 502 EUCLID AVE STE 200
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2984
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Country | US
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Telephone | 619-434-4019
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Fax | 619-461-5663
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Provider Business Mailing Address
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Address Line | 502 EUCLID AVE STE 200
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2984
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Country | US
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Telephone | 619-434-4019
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Fax | 619-461-5663
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A73257
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A73257
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License Number State | CA
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