MEDICARE: DR. VICKIE BRUNK

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	231H00000X	Audiologist	3804	CA
2	231H00000X	Audiologist	AU1787	CA

General Provider Information

NPI Number	:	1861438392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKIE BRUNK

Provider Business Mailing Address
First Line	:	FILE #55745
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-5745
Country	:	US
Telephone Number	:	619-644-9515
Fax Number	:

Provider Business Practice Location Address
First Line	:	5893 COPLEY DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7906
Country	:	US
Telephone Number	:	858-616-5472
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	12/07/2021

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Directions to “ DR. VICKIE BRUNK ” Practice Location

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