Provider Demographics
NPI:1407374523
Name:BRUSTOL, CARA ANN
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ANN
Last Name:BRUSTOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2500
Mailing Address - Country:US
Mailing Address - Phone:707-458-5335
Mailing Address - Fax:
Practice Address - Street 1:455 K ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-4107
Practice Address - Country:US
Practice Address - Phone:707-464-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist