Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G42170 | CA |
NPI | 1548233307 |
---|---|
Provider Name | Dr. Elliott Brunner |
First Address | Redondo Beach, CA 90277-3413 |
Second Address | Redondo Beach, CA 90277-3413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 14/01/2013 |