Provider Demographics
NPI:1801448915
Name:BROGAN, PATRICK IAN (CP)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:IAN
Last Name:BROGAN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 MISSION DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1827
Mailing Address - Country:US
Mailing Address - Phone:831-460-9245
Mailing Address - Fax:
Practice Address - Street 1:3321 MISSION DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1827
Practice Address - Country:US
Practice Address - Phone:831-460-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist