Healthcare Provider Details

I. General information

NPI: 1821093311
Provider Name (Legal Business Name): CORY LYNNE BRAME M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date: 03/20/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

4300 LONG BEACH BLVD STE 400
LONG BEACH CA
90807-2008
US

IV. Provider business mailing address

360 SAN MIGUEL DR STE 307
NEWPORT BEACH CA
92660-7829
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7700
  • Fax: 562-591-1311
Mailing address:
  • Phone: 949-721-0800
  • Fax: 949-721-9676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA74973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: