Provider Demographics
NPI:1215940283
Name:BREUNER, LISA M (DPM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BREUNER
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:5725 W LAS POSITAS BLVD
Mailing Address - Street 2:STE 280
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4059
Mailing Address - Country:US
Mailing Address - Phone:925-416-0990
Mailing Address - Fax:925-416-1843
Practice Address - Street 1:5565 W LAS POSITAS BLVD
Practice Address - Street 2:130
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-416-0990
Practice Address - Fax:925-416-1843
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE3559213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35590Medicare ID - Type Unspecified
T92235Medicare UPIN