Provider Demographics
NPI:1841516390
Name:POZOS-BREWER, RANDOLFO RAFAEL
Entity type:Individual
Prefix:
First Name:RANDOLFO
Middle Name:RAFAEL
Last Name:POZOS-BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:
Other - Last Name:POZOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6512
Mailing Address - Country:US
Mailing Address - Phone:510-282-9794
Mailing Address - Fax:
Practice Address - Street 1:920 PARK ROW
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2407
Practice Address - Country:US
Practice Address - Phone:510-282-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7598237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist