Provider Demographics
NPI:1639272511
Name:BRUAN, OWEN MEL CASEM (RPT)
Entity Type:Individual
Prefix:
First Name:OWEN MEL
Middle Name:CASEM
Last Name:BRUAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7463 GAYNESWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3939
Mailing Address - Country:US
Mailing Address - Phone:619-708-6322
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-425-8172
Practice Address - Fax:619-425-8337
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28716225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic