Active NPI
Emily Bruckner, MD
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1508292996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A124722
- Practice address
- 12301 Wilshire Blvd Ste 120
Los Angeles, CA 90025-1099 - Phone
- (310) 979-7337
- Fax
- (310) 979-7338
- NPI assigned
- Sep 18, 2013
- Sex
- Female
- Sole proprietor
- No
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 | A124722 | CA | Primary |
Addresses
Primary practice location
12301 Wilshire Blvd Ste 120
Los Angeles, CA 90025-1099
Mailing address
12301 Wilshire Blvd Ste 120
Los Angeles, CA 90025-1099
Phone (310) 979-7337
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 |
|---|---|---|---|
| A124722 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Regents of the University of California | 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
- Santa Monica, CA
- NPI 1982849105
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440374400000",
"number": "1508292996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12301 WILSHIRE BLVD STE 120",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251099",
"telephone_number": "310-979-7337",
"fax_number": "310-979-7338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12301 WILSHIRE BLVD STE 120",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251099",
"telephone_number": "310-979-7337",
"fax_number": "310-979-7338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCKNER",
"first_name": "EMILY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-18",
"last_updated": "2015-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A124722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.