Provider Demographics
NPI:1770130676
Name:BRUNT, DAMIEN CHRISTIAN
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:CHRISTIAN
Last Name:BRUNT
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 1:5100 MCCLOUD DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-2817
Mailing Address - Country:US
Mailing Address - Phone:415-827-6608
Mailing Address - Fax:
Practice Address - Street 1:425 UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6508
Practice Address - Country:US
Practice Address - Phone:916-284-1416
Practice Address - Fax:916-405-3539
Is Sole Proprietor?:No
Enumeration Date:2019-08-25
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program