Provider Demographics
NPI:1093742173
Name:VAN VRANKEN, BRUCE HARRIS (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HARRIS
Last Name:VAN VRANKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24331 EL TORO RD STE 330
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2754
Practice Address - Country:US
Practice Address - Phone:949-716-0833
Practice Address - Fax:949-716-0830
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G32570Medicaid
CA00G32570Medicaid
CAA19161Medicare UPIN