Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 42891 | CA |
NPI | 1013039122 |
---|---|
Provider Name | Dr. Sasson Brumand |
First Address | San Diego, CA 92172-1182 |
Second Address | San Diego, CA 92108-2611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |