Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 105722 | CA |
Y | 213EG0000X | General Practice | 105722 | CA |
NPI | 1003415183 |
---|---|
Provider Name | Ashley Brumell |
First Address | Walnut, CA 91789-2044 |
Second Address | Chino, CA 91710-5463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2020 |
Last Update Date | 14/12/2021 |