MEDICARE: MRS. KERI BRUNER

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	103K00000X	Behavior Analyst	1093009193	WA

General Provider Information

NPI Number	:	1518419621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERI BRUNER

Provider Business Mailing Address
First Line	:	13995 EL MONTE RD
Second Line	:
City	:	LAKESIDE
State	:	CA
Zip	:	92040-2650
Country	:	US
Telephone Number	:	619-905-7378
Fax Number	:

Provider Business Practice Location Address
First Line	:	13995 EL MONTE RD
Second Line	:
City	:	LAKESIDE
State	:	CA
Zip	:	92040-2650
Country	:	US
Telephone Number	:	619-905-7378
Fax Number	:

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

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/25/2016

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Directions to “ MRS. KERI BRUNER ” Practice Location

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