Active NPI
Laura Bruckner, M.D.
- Pediatrics Physician
- Encino, CA
National Provider Identifier
1013097922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G42766
- Practice address
- 5400 Balboa Blvd Ste 326
Encino, CA 91316-5214 - Phone
- (818) 789-8775
- Fax
- (818) 789-6726
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G42766 | CA | Primary |
Addresses
Primary practice location
5400 Balboa Blvd Ste 326
Encino, CA 91316-5214
Mailing address
5400 Balboa Blvd Ste 326
Encino, CA 91316-5214
Phone (818) 789-8775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G42766 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tarzana Medical Center LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Tarzana, CA
- NPI 1821250762
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013097922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5400 BALBOA BLVD STE 326",
"city": "ENCINO",
"state": "CA",
"postal_code": "913165214",
"telephone_number": "818-789-8775",
"fax_number": "818-789-6726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5400 BALBOA BLVD STE 326",
"city": "ENCINO",
"state": "CA",
"postal_code": "913165214",
"telephone_number": "818-789-8775",
"fax_number": "818-789-6726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCKNER",
"first_name": "LAURA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G42766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.