Provider Demographics
NPI:1124096656
Name:BRANTZ, EDWARD AARON (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:AARON
Last Name:BRANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1804 GARNET AVE
Mailing Address - Street 2:#439
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3352
Mailing Address - Country:US
Mailing Address - Phone:858-273-6093
Mailing Address - Fax:
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:SUITE # B103 PERLMAN CLINIC DE ANZA VIEW MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5404
Practice Address - Country:US
Practice Address - Phone:858-273-6093
Practice Address - Fax:858-273-7755
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA31523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A315230Medicaid
CA00A315230Medicaid