Basic Information
| Provider Information | |||||||||
| NPI: | 1053618835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRET POWERS DO INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1007 | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925641007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517193330 | ||||||||
| FaxNumber: | 9512966741 | ||||||||
| Practice Location | |||||||||
| Address1: | 4234 RIVERWALK PKWY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925058510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512700882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2011 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | POWERS | ||||||||
| AuthorizedOfficialFirstName: | BRET | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9512700882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 20A9577 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.