MEDICARE: ZANE PATRICIA BRUCK MFT

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	106H00000X	Marriage & Family Therapist	MFC24825	CA

General Provider Information

NPI Number	:	1417904160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZANE PATRICIA BRUCK MFT

Provider Business Mailing Address
First Line	:	546 RANCHO SANTA FE RD
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-6540
Country	:	US
Telephone Number	:	760-942-2443
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 KEARNY VILLA RD
Second Line	:	SUITE 116
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1578
Country	:	US
Telephone Number	:	858-279-1223
Fax Number	:

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/08/2007

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