Healthcare Provider Details

I. General information

NPI: 1780443598
Provider Name (Legal Business Name): GREGORY BRAVERMAN MD MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 EDWARDS CT STE 102
BURLINGAME CA
94010-2429
US

IV. Provider business mailing address

339 BALBOA ST
SAN FRANCISCO CA
94118-3935
US

V. Phone/Fax

Practice location:
  • Phone: 408-688-4737
  • Fax: 408-350-1895
Mailing address:
  • Phone: 408-688-4737
  • Fax: 408-350-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY BRAVERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 408-688-4737