MEDICARE: DARRELL S BRUGA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC 27208	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC 27208	OTHER	CA	CHIROPRACTOR

General Provider Information

NPI Number	:	1134270986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL S BRUGA D.C.

Provider Business Mailing Address
First Line	:	13980 BLOSSOM HILL RD STE D
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-5121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13980 BLOSSOM HILL RD STE D
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-5121
Country	:	US
Telephone Number	:	408-264-1021
Fax Number	:	408-264-5894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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