Provider Demographics
NPI:1679343099
Name:GARCIA-RUDDY, BRISSA
Entity Type:Individual
Prefix:
First Name:BRISSA
Middle Name:
Last Name:GARCIA-RUDDY
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 1:384 S TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2502
Mailing Address - Country:US
Mailing Address - Phone:714-771-3883
Mailing Address - Fax:
Practice Address - Street 1:384 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2502
Practice Address - Country:US
Practice Address - Phone:714-771-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management