Basic Information
| Provider Information | |||||||||
| NPI: | 1710364112 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRUIN NEUROPHYSIOLOGY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 731515 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753731515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843518459 | ||||||||
| FaxNumber: | 4843518810 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 SHORELINE DR APT 406 | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945015990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103661567 | ||||||||
| FaxNumber: | 4843518810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | SOFFER | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4843518417 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.