1609940048 NPI number — DR. RALPH EUGENE BRUNEAU III PHD MFT

Table of content: DR. RALPH EUGENE BRUNEAU III PHD MFT (NPI 1609940048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609940048 NPI number — DR. RALPH EUGENE BRUNEAU III PHD MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNEAU
Provider First Name:
RALPH
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PHD MFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609940048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
252 N. LARCHMONT BLVD.
Provider Second Line Business Mailing Address:
STE. 202
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90004-3707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-962-9619
Provider Business Mailing Address Fax Number:
323-463-4489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
252 N. LARCHMONT BLVD.
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90004-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-962-9619
Provider Business Practice Location Address Fax Number:
323-463-4489
Provider Enumeration Date:
11/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC33596 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com