Provider Demographics
NPI:1427083963
Name:BRYAN E BRUNS MD A MEDICAL CORP
Entity type:Organization
Organization Name:BRYAN E BRUNS MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-535-0091
Mailing Address - Street 1:PO BOX 511278
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-7833
Mailing Address - Country:US
Mailing Address - Phone:866-284-2771
Mailing Address - Fax:800-334-1041
Practice Address - Street 1:9255 TOWNE CENTRE DR
Practice Address - Street 2:SUITE 370
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3033
Practice Address - Country:US
Practice Address - Phone:858-535-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG296422084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G296420Medicaid
CA00G296420Medicaid
CAG29642Medicare ID - Type Unspecified