Provider Demographics
NPI:1609029073
Name:BRUFFETT, CRYSTAL ANNE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANNE
Last Name:BRUFFETT
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 1:8352 CHURCH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4449
Mailing Address - Country:US
Mailing Address - Phone:408-848-6511
Mailing Address - Fax:
Practice Address - Street 1:8352 CHURCH ST
Practice Address - Street 2:SUITE C
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4449
Practice Address - Country:US
Practice Address - Phone:408-848-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker