Provider Information for 1881764462
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Mr. KEVIN LEOPOLD BRUGMAN
Sex: Male
NPI: 1881764462
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1881764462 | ||||||||
| Enumeration Date | 2006-11-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2409 MIGRATION DR ELK GROVE, CA 95757-8167 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 3951 PERFORMANCE DR STE G SACRAMENTO, CA 95838-3264 United States Phone: 916-921-0828 | Fax:916-921-0333 | ||||||||
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