Provider Demographics
NPI:1912231705
Name:BRUMBACK, AUDREY CHRISTINE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:CHRISTINE
Last Name:BRUMBACK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCSF DEPT OF NEUROLOGY 505 PARNASSUS AVE
Mailing Address - Street 2:ROOM M798, BOX 0114
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-1489
Mailing Address - Fax:415-476-3428
Practice Address - Street 1:UCSF DEPT OF NEUROLOGY 505 PARNASSUS AVE
Practice Address - Street 2:ROOM M798, BOX 0114
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-476-1489
Practice Address - Fax:415-476-3428
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1110712084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program