Provider Demographics
NPI:1942758495
Name:BRUMSTED, EMILY LUCILLE (RDN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LUCILLE
Last Name:BRUMSTED
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 GEARY BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1794
Mailing Address - Country:US
Mailing Address - Phone:307-413-8283
Mailing Address - Fax:
Practice Address - Street 1:6620 GEARY BLVD APT 8
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1794
Practice Address - Country:US
Practice Address - Phone:307-413-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86053012133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered