Provider Demographics
NPI:1912145327
Name:BRUENING FOOT AND ANKLE INC
Entity Type:Organization
Organization Name:BRUENING FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:BRUENING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:909-957-6706
Mailing Address - Street 1:219 W BADILLO ST
Mailing Address - Street 2:A
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1907
Mailing Address - Country:US
Mailing Address - Phone:909-957-6706
Mailing Address - Fax:626-915-8779
Practice Address - Street 1:219 W BADILLO ST
Practice Address - Street 2:A
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1907
Practice Address - Country:US
Practice Address - Phone:909-957-6706
Practice Address - Fax:626-915-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730264698OtherPERSONAL NPI
U78974Medicare UPIN