Individual
DR. BRENT W FUNDINGSLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 W ARBOR DR, SAN DIEGO, CA 92103-9000
(800) 926-8273
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
(800) 926-8273
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G76891
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G768911
—
CA
Enumeration date
03/01/2006
Last updated
06/08/2021
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