Healthcare Provider Details

I. General information

NPI: 1457025645
Provider Name (Legal Business Name): KATHERINE ANNE BRAUN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR STE 901
BEVERLY HILLS CA
90210-4212
US

IV. Provider business mailing address

1134 SAN YSIDRO DR
BEVERLY HILLS CA
90210-2103
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-3000
  • Fax: 310-273-8802
Mailing address:
  • Phone: 310-593-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: