Provider Demographics
NPI:1215120381
Name:BRAZINSKY, BRUCE ALLEN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:BRAZINSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:STE. 2201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5253
Mailing Address - Country:US
Mailing Address - Phone:619-583-8592
Mailing Address - Fax:619-583-8170
Practice Address - Street 1:6699 ALVARADO RD
Practice Address - Street 2:STE. 2201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5253
Practice Address - Country:US
Practice Address - Phone:619-583-8592
Practice Address - Fax:619-583-8170
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3870213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38701Medicaid
CA480025320OtherMEDICARE ID TYPE UNSPECIFIED
CA480025320OtherMEDICARE ID TYPE UNSPECIFIED
CAWE3870BMedicare PIN
BB3204411OtherDEA
CA4338380001Medicare NSC