Basic Information
| Provider Information | |||||||||
| NPI: | 1487760997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WRUBEL | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 W EL CAMINO REAL FL 2 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940406203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048140 | ||||||||
| FaxNumber: | 5105067721 | ||||||||
| Practice Location | |||||||||
| Address1: | 2850 TELEGRAPH AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947051192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048140 | ||||||||
| FaxNumber: | 5105067721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 05/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | G70997 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | G70997 | 01 | CA | STATE MEDICAL LICENSE | OTHER |