Provider Demographics
NPI:1003085481
Name:BRUMMEL, KIRSTA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:KIRSTA
Middle Name:LYNN
Last Name:BRUMMEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KIRSTA
Other - Middle Name:LYNN
Other - Last Name:SCHOEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14781 POMERADO RD STE 520
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2802
Mailing Address - Country:US
Mailing Address - Phone:619-929-0818
Mailing Address - Fax:
Practice Address - Street 1:16776 BERNARDO CENTER DR STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2559
Practice Address - Country:US
Practice Address - Phone:619-929-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067987207W00000X
CA20A11590207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A11590Medicaid
GA52599673 001OtherBCBS/GA
CAFA071ZMedicare PIN