Provider Demographics
NPI:1083771877
Name:RUPP, BRIANNA LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEIGH
Last Name:RUPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4021
Mailing Address - Country:US
Mailing Address - Phone:330-701-7383
Mailing Address - Fax:
Practice Address - Street 1:USS TARAWA LHA 1 FPO AP 96622-1600
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136
Practice Address - Country:US
Practice Address - Phone:619-556-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9787208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice