Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DE00010886 | WA |
NPI | 1023208501 |
---|---|
Provider Name | Dr. Trina Marie Bruchal |
First Address | Bothell, WA 98011-5773 |
Second Address | Bothell, WA 98011-5773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2007 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023208501 | (05) | WA |