Healthcare Provider Details

I. General information

NPI: 1144397084
Provider Name (Legal Business Name): RICHARD D. BRUMLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W. SUNFLOWER AVE. SUITE 225
SANTA ANA CA
92704-6948
US

IV. Provider business mailing address

3401 W. SUNFLOWER AVE. SUITE 225
SANTA ANA CA
92704-6948
US

V. Phone/Fax

Practice location:
  • Phone: 714-619-8777
  • Fax: 714-619-8770
Mailing address:
  • Phone: 714-619-8777
  • Fax: 714-619-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberG40582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: