Provider Demographics
NPI:1558876946
Name:BROSGART, LUCIA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:BROSGART
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1930
Mailing Address - Country:US
Mailing Address - Phone:510-541-6200
Mailing Address - Fax:
Practice Address - Street 1:2438 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1930
Practice Address - Country:US
Practice Address - Phone:510-541-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife