Individual provider Active NPI

Kirsten Brossier Balano

  • Pharmacist
  • Santa Rosa, CA
National Provider Identifier
1376677328
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH44369 Issued in CA
Practice address
499 Humboldt St # 104
Santa Rosa, CA 95404-4214
Phone
(707) 565-7411
NPI assigned
Mar 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH44369 CA Primary

Addresses

Primary practice location

499 Humboldt St # 104
Santa Rosa, CA 95404-4214

Mailing address

499 Humboldt St # 104
Santa Rosa, CA 95404-4214
Phone (707) 565-7411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RPH44369CAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376677328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 HUMBOLDT ST # 104",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044214",
            "telephone_number": "707-565-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 HUMBOLDT ST # 104",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044214",
            "telephone_number": "707-565-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALANO",
        "first_name": "KIRSTEN",
        "middle_name": "BROSSIER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "RPH44369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.