Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 067987 | GA |
Y | 207W00000X | Ophthalmologist | 20A11590 | CA |
NPI | 1003085481 |
---|---|
Provider Name | Dr. Kirsta Lynn Brummel |
First Address | Poway, CA 92064-2032 |
Second Address | Poway, CA 92064-2032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2008 |
Last Update Date | 01/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020A11590 | (05) | CA |
52599673 001 | BCBS/GA (01) | GA |