MEDICARE: DR. OSCAR A BRACAMONTES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2763785	CA

General Provider Information

NPI Number	:	1851479802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSCAR A BRACAMONTES DDS

Provider Business Mailing Address
First Line	:	PO BOX 999
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91933-0999
Country	:	US
Telephone Number	:	619-946-1071
Fax Number	:	619-946-1071

Provider Business Practice Location Address
First Line	:	GERMAN GEDOVIUS 9505
Second Line	:	SUITE 104
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22010
Country	:	MX
Telephone Number	:	664-634-7461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/23/2016

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