Provider Demographics
NPI:1124097431
Name:BRUNER, DAWN L (MD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:L
Last Name:BRUNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13132 NEWPORT AVE
Mailing Address - Street 2:100
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3429
Mailing Address - Country:US
Mailing Address - Phone:714-565-7960
Mailing Address - Fax:714-565-7982
Practice Address - Street 1:13132 NEWPORT AVE
Practice Address - Street 2:100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3429
Practice Address - Country:US
Practice Address - Phone:714-565-7960
Practice Address - Fax:714-565-7982
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA42631208000000X
CAG426312080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics