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General NPI Number Information
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NPI Number | 1003085481
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Entity Type | Individual
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Provider Name | KIRSTA LYNN BRUMMEL DO
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Gender | Female
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 16776 BERNARDO CENTER DR STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92128-2559
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Country | US
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Telephone | 619-929-0818
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Fax |
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Provider Business Mailing Address
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Address Line | 14781 POMERADO RD STE 520
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City | POWAY
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State | CA
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Zip | 92064-2802
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Country | US
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Telephone | 619-929-0818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 067987
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 20A11590
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License Number State | CA
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