Provider Demographics
NPI:1457345225
Name:FRIEDMAN, BRUCE F (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:F
Last Name:FRIEDMAN
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 1:11180 WARNER AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7501
Mailing Address - Country:US
Mailing Address - Phone:714-549-9330
Mailing Address - Fax:714-549-9553
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-549-9330
Practice Address - Fax:714-549-9553
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53565207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52550Medicare UPIN
W10203Medicare PIN