Provider Demographics
NPI:1669762688
Name:BRUCKER, LINDSEY ERIN (MD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ERIN
Last Name:BRUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 SKYPARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4712
Mailing Address - Country:US
Mailing Address - Phone:310-378-2234
Mailing Address - Fax:310-378-9795
Practice Address - Street 1:3701 SKYPARK DR STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4712
Practice Address - Country:US
Practice Address - Phone:310-378-2234
Practice Address - Fax:310-378-9795
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130120207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine