Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | C035147 | CA |
NPI | 1255309555 |
---|---|
Provider Name | James Andrew Brunberg |
First Address | Sacramento, CA 95817 |
Second Address | Sacramento, CA 95817-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 13/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B18232 | (02) | CA |