| Provider / Organization | NPI | Date Certified |
|---|---|---|
| BRIAN BOURKE | 1851042337 | 2022-01-15 |
Brian Bourke is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1851042337.
| Entity Type | Individual |
| Provider Name | Brian Bourke |
| Practice Office Address | 70 DORAY DR PLEASANT HILL, CA US |
| Practice Office Telephone | 5107030402 |
| Mailing Address | 153 SKYWAY DR VALLEJO, CA 945914026 US |
| Business Telephone | 5107030402 |
| Code | Practice | License No State |
|---|---|---|
| 101200000X PRIMARY | ||
| 193400000X SING | Group Code |