Provider Demographics
NPI:1932240587
Name:LAWRENCE E BRUNEL , M.D., INC.
Entity Type:Organization
Organization Name:LAWRENCE E BRUNEL , M.D., INC.
Other - Org Name:SONORA MEDICAL GROUP INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRUNEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACOG
Authorized Official - Phone:209-532-5121
Mailing Address - Street 1:900 GREENLEY RD
Mailing Address - Street 2:SUITE 920
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5287
Mailing Address - Country:US
Mailing Address - Phone:209-532-5121
Mailing Address - Fax:209-532-6017
Practice Address - Street 1:900 GREENLEY RD
Practice Address - Street 2:SUITE 920
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5287
Practice Address - Country:US
Practice Address - Phone:209-532-5121
Practice Address - Fax:209-532-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG286930174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G286930Medicaid
CAZZZ32926ZMedicare PIN
CAE84236Medicare UPIN