Individual
BRENDA GERALDINE VAN LOGGEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6920 MIRAMAR RD, SAN DIEGO, CA 92121-2632
(858) 935-7379
Mailing address
31570 EAGLE ROCK WAY, LAGUNA BEACH, CA 92651-8299
(949) 715-0464
(949) 715-0464
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
589781
CA
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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