Provider Demographics
NPI:1336603760
Name:BRUNACHE, PAUL GERALD
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GERALD
Last Name:BRUNACHE
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 1:6524 COMPASS ROSE CT
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6427
Mailing Address - Country:US
Mailing Address - Phone:954-588-4701
Mailing Address - Fax:
Practice Address - Street 1:6524 COMPASS ROSE CT
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6427
Practice Address - Country:US
Practice Address - Phone:954-588-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL737679Medicaid