MEDICARE: DR. BRUNEL BREDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A75486	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407925860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUNEL BREDY MD

Provider Business Mailing Address
First Line	:	122 SAN ANTONIO DRIVE
Second Line	:
City	:	KING CITY
State	:	CA
Zip	:	93930-2942
Country	:	US
Telephone Number	:	831-385-5944
Fax Number	:	831-385-8618

Provider Business Practice Location Address
First Line	:	122 SAN ANTONIO DRIVE
Second Line	:
City	:	KING CITY
State	:	CA
Zip	:	93930-2942
Country	:	US
Telephone Number	:	831-385-5944
Fax Number	:	831-385-8618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	01/17/2022

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