Provider Demographics
NPI:1396741997
Name:BRUCE A. BRAZINSKY, A PODIATRY CORPORATION
Entity type:Organization
Organization Name:BRUCE A. BRAZINSKY, A PODIATRY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BRAZINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:619-583-8592
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:STE 2201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5253
Mailing Address - Country:US
Mailing Address - Phone:619-583-8592
Mailing Address - Fax:619-583-8170
Practice Address - Street 1:6699 ALVARADO RD
Practice Address - Street 2:STE 2201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5253
Practice Address - Country:US
Practice Address - Phone:619-583-8592
Practice Address - Fax:619-583-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3870213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38701Medicaid
CA480025320OtherRAILROAD MEDICARE
CA480025320OtherRAILROAD MEDICARE
BB3204411OtherDEA
CA4338380001Medicare NSC