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General NPI Number Information
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NPI Number | 1699947192
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Entity Type | Individual
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Provider Name | BRENT TIMOTHY KUNZLER PA
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Gender | Male
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 207 W LEGION RD
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City | BRAWLEY
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State | CA
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Zip | 92227-7780
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Country | US
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Telephone | 760-351-3130
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Fax | 760-351-3137
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Provider Business Mailing Address
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Address Line | 490 PAINTBRUSH WAY
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City | ST GEORGE
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State | UT
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Zip | 84790-8319
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Country | US
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Telephone | 435-272-9239
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA19659
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License Number State | CA
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