Provider Demographics
NPI:1639389497
Name:LANNI BRUTON, MARIA LISA (CNM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LISA
Last Name:LANNI BRUTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LISA
Other - Last Name:LANNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:4437 MAYCREST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1301
Mailing Address - Country:US
Mailing Address - Phone:203-246-9324
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE 430
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-794-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1823367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife