Healthcare Provider Details

I. General information

NPI: 1053741587
Provider Name (Legal Business Name): BARBARA R. KUGELMANN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST
SANTA ANA CA
92701-3640
US

IV. Provider business mailing address

1200 NO. MAIN STREET SUITE 301
SANTA ANA CA
90701-5273
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-4639
  • Fax:
Mailing address:
  • Phone: 714-480-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRI-K1312191350
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number334794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: