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General NPI Number Information
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NPI Number | 1740211838
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Entity Type | Individual
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Provider Name | PHILLIP DE EVANS BRETZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 35280 BOB HOPE DR SUITE 103
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1753
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Country | US
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Telephone | 760-324-8323
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Fax | 760-324-8779
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Provider Business Mailing Address
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Address Line | PO BOX 600534
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City | SAN DIEGO
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State | CA
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Zip | 92160-0534
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Country | US
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Telephone | 800-775-6029
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Fax | 619-220-0905
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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 | A32596
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License Number State | CA
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