Provider Demographics
NPI:1306217914
Name:BRUAN, CHARITO CASTRO
Entity Type:Individual
Prefix:
First Name:CHARITO
Middle Name:CASTRO
Last Name:BRUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARITO
Other - Middle Name:CASTRO
Other - Last Name:BRUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:7463 GAYNESWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3939
Mailing Address - Country:US
Mailing Address - Phone:619-335-3145
Mailing Address - Fax:
Practice Address - Street 1:7463 GAYNESWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3939
Practice Address - Country:US
Practice Address - Phone:619-335-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA810780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse