Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT20093 | CA |
NPI | 1003374505 |
---|---|
Provider Name | Brad Edward Budde |
First Address | Capistrano Beach, CA 92624-1310 |
Second Address | Capistrano Beach, CA 92624-1310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 09/10/2019 |