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NPI Code Detail

MEDICARE: BRUCE SUNBERG

MEDICARE:   BRUCE  SUNBERG
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1487018396
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE SUNBERG
Provider Business Mailing Address
First Line : 300 E H ST
Second Line :
City : BENICIA
State : CA
Zip : 94510-3341
Country : US
Telephone Number : 707-373-6011
Fax Number :
Provider Business Practice Location Address
First Line : 623 GREAT JONES ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6005
Country : US
Telephone Number : 707-429-8888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2016
Last Update Date : 04/06/2016

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Directions to “ BRUCE SUNBERG ” Practice Location

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