Healthcare Provider Details

I. General information

NPI: 1316590425
Provider Name (Legal Business Name): CAROL ANN BRUGGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 NORTHPOINT PKWY
SANTA ROSA CA
95407-5004
US

IV. Provider business mailing address

2300 NORTHPOINT PKWY
SANTA ROSA CA
95407-5004
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-5581
  • Fax: 707-571-5531
Mailing address:
  • Phone: 707-571-5581
  • Fax: 707-571-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: