Healthcare Provider Details

I. General information

NPI: 1619158334
Provider Name (Legal Business Name): JULIE DENISE BRUMBAUGH IMF 43514
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 S HARGRAVE ST
BANNING CA
92220-6169
US

IV. Provider business mailing address

1627 S HARGRAVE ST
BANNING CA
92220-6169
US

V. Phone/Fax

Practice location:
  • Phone: 951-922-7612
  • Fax:
Mailing address:
  • Phone: 951-922-7612
  • Fax: 858-514-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 43514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: