Individual
BRUCE M PRENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2655 CAMINO DEL RIO N, # 120, SAN DIEGO, CA 92108-1633
(619) 286-6687
(619) 286-6695
Mailing address
PO BOX 2305, SKYLAND, NC 28776-2305
(828) 575-2644
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
G21931
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G219310
—
CA
01
—
GW214Z
MEDICARE PTAN
CA
Enumeration date
04/22/2006
Last updated
11/10/2015
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