Healthcare Provider Details

I. General information

NPI: 1336335280
Provider Name (Legal Business Name): BARRY M BRAIKER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WILSHIRE BLVD STE 206
BEVERLY HILLS CA
90211-2930
US

IV. Provider business mailing address

8670 WILSHIRE BLVD STE 206
BEVERLY HILLS CA
90211-2930
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-2915
  • Fax: 310-855-0753
Mailing address:
  • Phone: 310-659-2915
  • Fax: 310-855-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA22980
License Number StateCA

VIII. Authorized Official

Name: BARRY M BRAIKER
Title or Position: DOCTOR
Credential: M.D.
Phone: 310-659-2915