Provider Demographics
NPI:1356347298
Name:GINIER, BRUCE LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEONARD
Last Name:GINIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320757
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0112
Mailing Address - Country:US
Mailing Address - Phone:888-318-8900
Mailing Address - Fax:
Practice Address - Street 1:9913 N SEDONA CIR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-5410
Practice Address - Country:US
Practice Address - Phone:888-318-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA457082085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A457080Medicaid
CA00A457080Medicare ID - Type Unspecified
CA00A457080Medicaid