Healthcare Provider Details

I. General information

NPI: 1912231705
Provider Name (Legal Business Name): AUDREY CHRISTINE BRUMBACK MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSF DEPT OF NEUROLOGY 505 PARNASSUS AVE ROOM M798, BOX 0114
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

UCSF DEPT OF NEUROLOGY 505 PARNASSUS AVE ROOM M798, BOX 0114
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1489
  • Fax: 415-476-3428
Mailing address:
  • Phone: 415-476-1489
  • Fax: 415-476-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA111071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: