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NPI Code Detail

MEDICARE: JORGE JESUS BRU

MEDICARE: JORGE JESUS BRU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1073768495
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE JESUS BRU
Provider Business Mailing Address
First Line : 1178 BROADWAY AVE
Second Line :
City : SEASIDE
State : CA
Zip : 93955-4934
Country : US
Telephone Number : 831-394-4622
Fax Number : 831-394-1930
Provider Business Practice Location Address
First Line : 1178 BROADWAY AVE
Second Line :
City : SEASIDE
State : CA
Zip : 93955-4934
Country : US
Telephone Number : 831-394-4622
Fax Number : 831-394-1930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2008
Last Update Date : 11/26/2008

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Directions to “ JORGE JESUS BRU ” Practice Location

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