MEDICARE: JACQUELINE BROGAN MD

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1326603028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE BROGAN MD

Provider Business Mailing Address
First Line	:	246 5TH ST
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-3256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 PROSPECT PL STE 260
Second Line	:
City	:	CORONADO
State	:	CA
Zip	:	92118-1987
Country	:	US
Telephone Number	:	619-437-1146
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	JACQUELINE BROGAN
Credential	:	MD
Telephone Number	:	805-331-1763

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	02/25/2020

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