Provider Demographics
NPI:1336937655
Name:BRUNSON-HILL, TRACY T
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:T
Last Name:BRUNSON-HILL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 CANDLEWOOD ST STE 14A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1927
Mailing Address - Country:US
Mailing Address - Phone:562-547-0150
Mailing Address - Fax:
Practice Address - Street 1:5150 CANDLEWOOD ST STE 14A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1927
Practice Address - Country:US
Practice Address - Phone:562-547-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1016824172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver