Provider Demographics
NPI:1255966859
Name:BRUNAT, JOB
Entity type:Individual
Prefix:MR
First Name:JOB
Middle Name:
Last Name:BRUNAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4169 38TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1367
Mailing Address - Country:US
Mailing Address - Phone:561-543-7302
Mailing Address - Fax:
Practice Address - Street 1:4169 38TH ST APT 10
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1367
Practice Address - Country:US
Practice Address - Phone:561-543-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health