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General NPI Number Information
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NPI Number | 1750457404
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Entity Type | Individual
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Provider Name | MARK A. BRONSTEIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 11180 WARNER AVE #163
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 714-751-1188
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Fax | 714-751-2403
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Provider Business Mailing Address
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Address Line | 11180 WARNER AVE STE 163
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7515
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Country | US
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Telephone | 714-751-1188
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Fax | 714-751-2403
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G44667
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License Number State | CA
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