Provider Demographics
NPI:1093742173
Name:VAN VRANKEN, BRUCE HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HARRIS
Last Name:VAN VRANKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24400 MUIRLANDS BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3946
Mailing Address - Country:US
Mailing Address - Phone:949-581-0400
Mailing Address - Fax:949-581-0694
Practice Address - Street 1:24400 MUIRLANDS BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3946
Practice Address - Country:US
Practice Address - Phone:949-581-0400
Practice Address - Fax:949-581-0694
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG32570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G32570Medicaid
CA00G32570Medicaid
CAA19161Medicare UPIN