Individual
DR. BRENTON D WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
502 EUCLID AVE STE 200, NATIONAL CITY, CA 91950-2984
(619) 434-4019
(619) 461-5663
Mailing address
502 EUCLID AVE STE 200, NATIONAL CITY, CA 91950-2984
(619) 434-4019
(619) 461-5663
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A73257
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
A73257
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W18884
MEDICARE GROUP NUMBER
CA
Enumeration date
08/09/2005
Last updated
06/24/2021
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