Provider Demographics
NPI: | 1760406979 |
---|---|
Name: | BRINGAS-JORGAN, FRANCISCO E (PA-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | FRANCISCO |
Middle Name: | E |
Last Name: | BRINGAS-JORGAN |
Suffix: | |
Gender: | M |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | HENRY |
Other - Middle Name: | |
Other - Last Name: | BRINGAS |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | PA-C |
Mailing Address - Street 1: | 39700 BOB HOPE DRIVE |
Mailing Address - Street 2: | SUITE 110 |
Mailing Address - City: | RANCHO MIRAGE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92270-7103 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 760-340-5545 |
Mailing Address - Fax: | 760-346-6208 |
Practice Address - Street 1: | 39700 BOB HOPE DRIVE |
Practice Address - Street 2: | SUITE 110 |
Practice Address - City: | RANCHO MIRAGE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92270-7103 |
Practice Address - Country: | US |
Practice Address - Phone: | 760-340-5545 |
Practice Address - Fax: | 760-346-6208 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-27 |
Last Update Date: | 2007-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PA17834 | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
Q61718 | Medicare UPIN | ||
0PA178340 | Medicare ID - Type Unspecified | MEDICARE NUMBER |