Bruce M Prenner, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

G21931 Issued in CA

Practice address

2655 Camino del Rio N
# 120
San Diego, CA 92108-1633

Phone

(619) 286-6687

Fax

(619) 286-6695

NPI assigned

Apr 22, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Allergy Associates Medical Group Inc

  • Allergy & Immunology Physician
  • San Diego, CA
  • NPI 1134333073
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447113600000",
    "number": "1104882729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2305",
            "city": "SKYLAND",
            "state": "NC",
            "postal_code": "287762305",
            "telephone_number": "828-575-2644",
            "fax_number": "828-350-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 CAMINO DEL RIO N",
            "address_2": "# 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081633",
            "telephone_number": "619-286-6687",
            "fax_number": "619-286-6695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENNER",
        "first_name": "BRUCE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-22",
        "last_updated": "2015-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "CA",
            "license": "G21931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G219310",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GW214Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premise Health of California Medical, P.C
• Premise Health of California Medical, P.C.
• Premium One Hospice, Inc.
• Sarah Premo
• Mary Beth Prendergast, RN, PHN, MN
• Colleen Sue Prentice, LCSW
• Jan Frazier Prentice, PA-C
• Monica Prentice
• Elise C Prepetit
• Prescribed Oxygen Inc

• Allergy & Immunology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Allergy & Immunology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.