Provider Demographics
NPI:1851113153
Name:BRUELAND, NATHAN HUNTER
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:HUNTER
Last Name:BRUELAND
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:CLAIRE
Other - Last Name:BRUELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14251 DANIELSON ST
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-8818
Mailing Address - Country:US
Mailing Address - Phone:858-699-7579
Mailing Address - Fax:
Practice Address - Street 1:14251 DANIELSON ST
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-8818
Practice Address - Country:US
Practice Address - Phone:858-699-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician