Provider Demographics
NPI:1619166220
Name:LISA BREUNER, DPM, INC.
Entity Type:Organization
Organization Name:LISA BREUNER, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREUNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:925-416-0990
Mailing Address - Street 1:5725 W LAS POSITAS BLVD
Mailing Address - Street 2:#280
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4054
Mailing Address - Country:US
Mailing Address - Phone:925-416-0990
Mailing Address - Fax:
Practice Address - Street 1:5725 W LAS POSITAS BLVD
Practice Address - Street 2:#280
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4054
Practice Address - Country:US
Practice Address - Phone:925-416-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3559213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT92235Medicare UPIN
CA000E35590Medicare PIN