Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 25588 | CA |
NPI | 1598067555 |
---|---|
Provider Name | Dr. Rigo Kurt Brueck |
First Address | Encinitas, CA 92024-3558 |
Second Address | Vista, CA 92084-1651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2010 |
Last Update Date | 19/05/2016 |