Provider Demographics
NPI:1407925860
Name:BREDY, BRUNEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUNEL
Middle Name:
Last Name:BREDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SAN ANTONIO DRIVE
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-2942
Mailing Address - Country:US
Mailing Address - Phone:831-385-5944
Mailing Address - Fax:831-385-8618
Practice Address - Street 1:122 SAN ANTONIO DRIVE
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-2942
Practice Address - Country:US
Practice Address - Phone:831-385-5944
Practice Address - Fax:831-385-8618
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53997FMedicaid
CAGR011110Medicaid
CARHM53997FMedicaid
CAH84570Medicare UPIN
CA553938Medicare ID - Type UnspecifiedRURAL MEDICARE NUMBER